P16 Hypopigmented Mycosis Fungoides in a Caucasian child

Abstract

Abstract We report a case of hypopigmented MF in an 8-year-old Caucasian boy whose skin had been managed as pityriasis alba for a number of years. On initial presentation to the emergency department, multiple non-itchy scattered hypopigmented macules were incidentally noted on the lower abdomen, groin, lateral flanks and axillae. Physical examination revealed widespread hypopigmented patches. Differential diagnoses included pityriasis alba or post inflammatory hypopigmentation secondary to atopic dermatitis. He was initially managed with mild to moderate corticosteroids and emollients, but continued to develop multiple atypical asymmetrical macules, particularly on the lower abdomen and groin. Although the skin was responsive to anti-inflammatory treatment, given the progression, a skin biopsy was requested. A lesional punch biopsy from the abdomen revealed focal lymphocyte exocytosis and interface change at the epidermis. Given the subtle findings the case was discussed at our histopathology MDT meeting. Further specialist review of the histopathology showed clinicopathological correlation in keeping with CD8+ mycosis fungoides (hypopigmented variant). He is currently managed with regular potent topical steroids, 0.1% topical tacrolimus. TL01 phototherapy has been suggested. Juvenile onset MF constitutes hypopigmented, poikilodermatosis, pityriasis lichenoides-like, folliculotropic, and pigmented purpura- like presentations1. Generally there is no disease progression beyond stage 1A or 1B disease2. Hypopigmented MF is well described in black and Asian skin types but it is also important to appreciate that multiple reoccurring atypical hypopigmented patches in Caucasian skin may also be a variant of hypopigmented MF.