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cutaneous pseudolymphomas have been classified according to their histologic and immunophenotypic characteristics or rather in relation to the lymphoma they simulate&#46; In other words&#44; they are categorized as cutaneous B-cell pseudolymphomas or cutaneous T-cell pseudolymphomas&#44; depending on the predominant lymphocytic component&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">9</span></a> While the distinction is frequently artificial&#44; this classification system is still the widely used system for categorizing pseudolymphomas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The list of cutaneous pseudolymphomas has grown in recent years with the inclusion of multiple reactive conditions with histopathologic features mimicking those of true lymphomas&#46; It is also noteworthy that several entities that were originally considered to be cutaneous pseudolymphomas have since been reclassified as low-grade lymphomas based on clinical and pathologic findings&#44; molecular biology studies&#44; and follow-up data&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Epidemiological data on cutaneous pseudolymphomas are scarce&#44; although B-cell pseudolymphomas appear to be more common than their T-cell counterparts&#44; and they are also more common in female patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">4&#44;5&#44;10</span></a> Cutaneous pseudolymphoma generally affects adults&#44; although it can occur at any age&#46; No familial cases have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The proliferation of skin-associated lymphoid tissue &#40;SALT&#41;&#44; the cutaneous analog of mucosa-associated lymphoid tissue &#40;MALT&#41;&#44; following antigenic stimulation has been proposed as a contributory factor in the pathogenesis of cutaneous pseudolymphoma &#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">11</span></a> Accordingly&#44; cutaneous pseudolymphoma could potentially progress to a true cutaneous lymphoma with permanent antigenic stimulation&#44; as occurs in the gastric mucosa in the presence of persistent <span class="elsevierStyleItalic">Helicobacter pylori</span> infection&#46;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">12</span></a> However&#44; while there have been some reports of progression to cutaneous lymphoma&#44;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">13&#8211;17</span></a> true progression from a correctly diagnosed pseudolymphoma is very rare&#44; if not impossible&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To diagnose cutaneous pseudolymphoma it is necessary to contrast clinical and histologic findings&#44; with assessment of the architecture and composition of the inflammatory infiltrate&#44; and to complement these findings with immunohistochemistry and gene rearrangement studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;18&#44;19</span></a> These clonality studies generally reveal a polyclonal pattern&#46; Nevertheless&#44; it is not always possible to demonstrate clonality in true lymphomas&#44; and certain pseudolymphomas have monoclonal B-cell and T-cell populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">5&#44;8&#44;20&#8211;26</span></a> Accordingly&#44; although gene arrangement studies are useful&#44; their results must be interpreted with caution and within the context of the data available&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the rest of this paper we will describe the main types of cutaneous pseudolymphoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Lupus Erythematosus Panniculitis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lupus with subcutaneous involvement&#44; a condition known as lupus erythematosus panniculitis&#44; can raise clinical and particularly histologic suspicions of panniculitis-like T-cell lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;27</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Lupus erythematosus panniculitis presents as plaques or subcutaneous nodules in areas rarely affected by other forms of panniculitis&#44; such as the face&#44; the shoulders&#44; and the proximal aspect of the arms&#46; Antinuclear antibodies and other diagnostic criteria for systemic lupus erythematosus may be absent&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologic examination shows a predominantly lobular panniculitis with dense lymphoid infiltrates in the deep dermis and the hypodermis&#44; along with wide fibrous septae on occasions&#46; The infiltrate is mixed&#44; with abundant B cells&#44; plasma cells&#44; and clusters of plasmacytoid dendritic cells&#44; frequently forming reactive germinal centers&#46; The dermal-epidermal junction may show the characteristic interface dermatitis associated with the underlying connective tissue disease&#44; and this is a key finding for the differential diagnosis&#46; In lupus erythematosus panniculitis&#44; unlike in panniculitis-like T-cell lymphoma&#44; histology does not show cytophagocytosis or adipocyte rimming &#40;atypical lymphoid cells surrounding the adipocytes&#41;&#46; T-cell receptor &#40;<span class="elsevierStyleItalic">TCR</span>&#41; gene rearrangement will show a polyclonal pattern&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;27</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histologic features of panniculitis-like T-cell lymphoma and lupus erythematosus panniculitis may&#44; albeit rarely&#44; overlap&#46; In one study of 83 patients with panniculitis-like T-cell lymphoma&#44; Willemze et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">28</span></a> observed abundant plasma cells interspersed with CD4<span class="elsevierStyleSup">&#43;</span> T cells in 4 patients who also had lupus erythematosus&#44; leading to an initial misdiagnosis of lupus erythematous panniculitis&#46; The presence of cellular atypia together with a loss of pan-T-cell markers and&#47;or clonal TCR-&#947; rearrangement was key to establishing a correct diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pseudolymphoma in Tattoos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Although uncommon&#44; pseudolymphomatous reactions to tattoo ink can occur&#44; and a variable latency period has been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">29&#44;30</span></a> Red ink is the most common ink involved in these reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">30</span></a> Tattoo ink&#8211;related pseudolymphoma presents as subcutaneous nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Histologic examination shows a dense diffuse dermal infiltrate with perivascular and periadnexal accentuation composed mainly of small lymphocytes &#40;most often T cells but there may also be B cells or a mixture&#41; and macrophages&#46; Additional findings include eosinophils&#44; plasma cells&#44; histiocytes&#44; and giant multinucleated cells&#46; These cells may form lymphoid follicles with germinal centers or patterns similar to those seen in mycosis fungoides&#46; Spongiosis&#44; exocytosis&#44; and basal vacuolar degeneration may also be observed in the epidermis&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">29&#44;30</span></a> The presence of macrophages phagocytizing the pigment is a key diagnostic clue&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pseudolymphoma at the Site of Vaccination</span><p id="par0070" class="elsevierStylePara elsevierViewall">An intense inflammatory response simulating cutaneous lymphoma can also occur at vaccination sites as the result of a delayed hypersensitivity reaction to vaccine components&#46; This reaction is particularly seen in vaccines containing aluminum&#44; as this metal contributes to the delayed absorption of other components&#44; thereby prolonging the antigen stimulus&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;31</span></a> It presents as papules or superficial or deep erythematous nodules&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;32</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The histologic pattern may be lichenoid&#44; simulating mycosis fungoides&#44; or nodular&#44; simulating follicle center lymphoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this second case&#44; however&#44; bcl-6<span class="elsevierStyleSup">&#43;</span> cells will not be observed outside the reactive germinal centers&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;33</span></a> Clusters of CD30<span class="elsevierStyleSup">&#43;</span> cells may occasionally be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0885"><span class="elsevierStyleSup">33</span></a> When aluminum is involved&#44; the histiocytes in the infiltrate&#44; which may be solitary or arranged in clusters forming epithelioid granulomas&#44; typically have abundant granular and basophilic cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; corresponding to intracellular aluminum deposits&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Lymphocytoma Cutis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Lymphocytoma cutis was first described by Spiegler in 1894&#46; It is the prototype of cutaneous B-cell pseudolymphoma and perhaps the most common variant&#46; It represents an exaggerated local immune response to diverse stimuli&#44; the most widely described of which are arthropod bites&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;32&#8211;37</span></a> One of the most classic associations is with the spirochete <span class="elsevierStyleItalic">Borrelia burgdorferi</span> following a bite from a <span class="elsevierStyleItalic">Ixodes</span> tick&#46;<a class="elsevierStyleCrossRefs" href="#bib0830"><span class="elsevierStyleSup">22&#44;38</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Lymphocytoma cutis typically presents as a solitary reddish nodule &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; or less frequently as plaques or crops of papules&#46; The face and neck are the most common sites of involvement&#46; Lesions on the earlobe&#44; nipples&#44; or scrotum are highly characteristic of <span class="elsevierStyleItalic">B&#160;burgdorferi</span>&#8211;associated lymphocytoma cutis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;38&#8211;40</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Miliarial-type lesions have also been described&#44; but less frequently&#46; These present as multiple&#44; symmetric&#44; monomorphous translucent micropapules on the head and neck and they can be asymptomatic or slightly pruritic&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;41&#44;42</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Histology reveals a dense nodular lymphoid infiltrate in the dermis&#44; with germinal centers that characteristically lack a mantle zone and may merge&#46; Although the infiltrate in pseudolymphomas tends to be top heavy &#40;i&#46;e&#46;&#44; more pronounced in the superficial dermis&#41; rather than bottom heavy like in lymphomas&#44; in <span class="elsevierStyleItalic">B&#160;burgdorferi</span>&#8211;associated lymphocytoma cutis&#44; infiltrates are often found throughout the dermis and even in the superficial layers of the subcutaneous tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The infiltrate is formed by plasma cells&#44; eosinophils&#44; abundant reactive T cells&#44; and tingible body macrophages &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; This heterogeneity is another factor to take into account when distinguishing cutaneous pseudolymphomas from true lymphomas&#44; as these tend to have a more uniform infiltrate&#46; The predominant immunophenotype is a germinal center B-cell type&#44; with positive staining for CD20&#44; CD10&#44; and bcl-6&#44; and negative staining for bcl-2&#46; The germinal centers tend to have a very high proliferative index&#44; but unlike in true cutaneous lymphomas&#44; cellular atypia and preservation of adnexal structures are not observed&#46; Rearrangement analysis usually&#44; but not always&#44; shows a polyclonal pattern&#46; Assessment of clonality in more than 1 lesion is very useful for differentiating pseudolymphomas and lymphomas in patients with several lesions&#46; Detection of the same clone in 2 lesions or in the same lesion at different stages of development would point to a diagnosis of lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;39&#44;43</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pseudolymphoma in Acrodermatitis Chronica Atrophicans Lesions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Pseudolymphoma has been described in the lesions of patients with acrodermatitis chronica atrophicans&#44; which is a delayed cutaneous manifestation of <span class="elsevierStyleItalic">B burgdorferi</span> infection&#46; Histologically&#44; lesions can display 2 patterns&#58; one simulating mycosis fungoides and the other &#40;less frequent&#41; one simulating cutaneous B-cell lymphoma&#46; The rearrangement study shows a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0940"><span class="elsevierStyleSup">44&#44;45</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pseudolymphomatous Folliculitis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Pseudolymphomatous folliculitis is a cutaneous pseudolymphoma characterized by the presence of hyperplastic hair follicles together with a lymphoid infiltrate that can mimic cutaneous lymphoma&#46; It presents with a single or&#44; less frequently&#44; several dome-shaped or nodular lesions on the face&#44; scalp&#44; or trunk&#46;<a class="elsevierStyleCrossRefs" href="#bib0780"><span class="elsevierStyleSup">12&#44;46</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Histologically&#44; pseudolymphomatous folliculitis can simulate small-to-medium-sized pleomorphic T-cell lymphoma&#44; follicle center B-cell lymphoma&#44; or even folliculotropic mycosis fungoides&#46; A dense lymphocytic infiltrate is located predominantly around the hair follicles&#44; which show hyperplastic changes and thickened walls&#46; Clusters of perifollicular S100<span class="elsevierStyleSup">&#43;</span> and CD1A<span class="elsevierStyleSup">&#43;</span> histiocytes may occasionally be seen&#46; Rearrangement studies show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;12&#44;46&#8211;50</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Lymphomatoid Drug Reaction</span><p id="par0120" class="elsevierStylePara elsevierViewall">Numerous drugs can induce cutaneous lymphoid infiltrates that resemble lymphoma clinically&#44; histologically&#44; or both clinically and histologically&#46; The most frequently implicated drugs are anticonvulsants and antihypertensives&#44; but others have been described &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Clinically&#44; lymphomatoid drug reactions present as generalized papules&#44; plaques&#44; or nodules&#44; or even erythroderma&#44; sometimes with accentuation in sun-exposed areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;61</span></a> Lesions typically appear 2 to 8 weeks after the introduction of the offending drug&#44; but later onset has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;42&#44;62</span></a> The skin lesions may be accompanied by enlarged lymph nodes&#44; fever&#44; and less frequently hepatosplenomegaly&#44; joint pain&#44; and diverse blood test alterations including elevated liver enzymes and eosinophilia&#44; particularly in cases due to anticonvulsants&#46;<a class="elsevierStyleCrossRefs" href="#bib1025"><span class="elsevierStyleSup">61&#44;63</span></a> Circulating S&#233;zary cells may occasionally be detected&#46;<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">36</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Histologic findings in lymphomatoid drug reaction include a band-like T&#160;cell&#8211;predominant infiltrate with epidermal spongiosis and exocytosis&#44; simulating mycosis fungoides&#46; On other occasions&#44; there may be a nodular or diffuse B-cell pattern with formation of germinal centers&#44; simulating follicle center or marginal zone B-cell lymphoma&#46; Cellular atypia has been described in some cases&#44; as have abundant CD30<span class="elsevierStyleSup">&#43;</span> cells&#44; which can complicate diagnosis&#46; Findings suggestive of lymphomatoid drug reaction include necrotic keratinocytes&#44; red blood cell extravasation&#44; pigmentary incontinence&#44; dermal edema&#44; absence of fibrosis in the papillary dermis&#44; presence of other inflammatory cells in the infiltrate&#44; and finally&#44; negative clonality in the gene rearrangement study&#46; Lesions in sun-exposed areas can also point to a diagnosis of lymphomatoid drug reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0930"><span class="elsevierStyleSup">42&#44;43&#44;61&#44;64&#8211;68</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The condition resolves after a variable period of time on withdrawal of the drug and returns when it is reintroduced&#46;<a class="elsevierStyleCrossRefs" href="#bib0930"><span class="elsevierStyleSup">42&#44;43</span></a> There have been very rare reports of progression to true cutaneous lymphoma&#44;<a class="elsevierStyleCrossRef" href="#bib1065"><span class="elsevierStyleSup">69</span></a> and in these cases the skin lesions would not disappear after withdrawal of the drug&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Morphea</span><p id="par0140" class="elsevierStylePara elsevierViewall">Collagen involvement is often not very evident in the inflammatory phase of connective tissue disorders&#44; especially in localized scleroderma&#44; and histology may reveal dense lymphoid infiltrates simulating cutaneous lymphoma and marginal zone B-cell lymphoma in particular&#46; Plasma cells are almost always present and light chain gene rearrangement studies will show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;70&#44;71</span></a> It is essential to contrast clinical and pathologic findings in such cases&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Acral Pseudolymphomatous Angiokeratoma&#47;Small Papular Pseudolymphoma</span><p id="par0145" class="elsevierStylePara elsevierViewall">Acral pseudolymphomatous angiokeratoma&#44; which was originally described under the acronym APACHE &#40;acral pseudolymphoma angiokeratoma in children&#41;&#44; is a rare benign condition of unknown etiology and pathogenesis&#44; although some authors believe it is a hypersensitivity reaction to insect bites&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">4&#44;6&#44;72&#44;73</span></a> It is characterized by papules or clusters of asymptomatic red-purple nodules&#44; typically located at acral sites&#44; and is more common in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;36&#44;72&#8211;75</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Histologic findings include a dense well-differentiated nodular B-cell and T-cell infiltrate that generally spares the adnexal structures&#44; in addition to plasma cells&#44; eosinophils&#44; and on occasions histiocytes and giant multinucleated cells&#46; A proliferation of capillary vessels may be observed&#46; The epidermis is normally spared&#44; although there have been reports of basal vacuolization&#44; exocytosis&#44; and spongiosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;72</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">T Cell&#8211;Rich Angiomatoid Polypoid Pseudolymphoma</span><p id="par0155" class="elsevierStylePara elsevierViewall">T cell&#8211;rich angiomatoid polypoid pseudolymphoma has similar histologic findings to acral pseudolymphomatous angiokeratoma&#44; but it is characterized by solitary polypoid lesions at nonacral sites&#44; with a predilection for the head and trunk&#46; It typically affects young adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;76&#44;77</span></a> Another difference between the 2 entities is that in angiomatoid polypoid pseudolymphoma&#44; there is a predominance of CD4<span class="elsevierStyleSup">&#43;</span> T cells in the infiltrate and the prominent thick-walled vessels seen in acral pseudolymphomatous angiokeratoma are absent&#46; Both entities must be distinguished from angioplasmacellular hyperplasia&#44; in which the infiltrate is much richer in plasma cells&#46;<a class="elsevierStyleCrossRefs" href="#bib1100"><span class="elsevierStyleSup">76&#8211;78</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pretibial Lymphoplasmacytic Plaque in Children</span><p id="par0160" class="elsevierStylePara elsevierViewall">Pretibial lymphoplasmacytic plaque is a benign chronic condition of unknown etiology that is probably reactive in nature&#46; It presents as red-purple asymptomatic papules or well-delimited plaques that preferentially affect the anterior surface of the tibia in children&#46; Histologically&#44; it is similar to acral pseudolymphomatous angiokeratoma&#44; although there is a much more pronounced presence of plasma cells&#44; together with lymphocytes and prominent vessels&#46; Vacuolization&#44; exocytosis&#44; and apoptotic bodies may be observed in the epidermis&#46; The gene rearrangement study shows a polyclonal pattern&#46;<a class="elsevierStyleCrossRefs" href="#bib1115"><span class="elsevierStyleSup">79&#8211;82</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Secondary Syphilis</span><p id="par0165" class="elsevierStylePara elsevierViewall">Histology of secondary syphilis lesions and less frequently of primary or tertiary syphilis lesions may occasionally reveal a lymphoplasmacytic infiltrate simulating marginal zone B-cell cutaneous lymphoma&#46; The coexistence of interface&#47;lichenoid dermatitis or granulomatous inflammation is an important diagnostic clue&#46; Rearrangement studies show a polyclonal pattern and specific immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span> confirms the presence of these organisms&#46; Lesions resolve quickly with antibiotic treatment&#46; It is also worth noting that certain cases of malignant syphilis may also feature lesions that are clinically indistinguishable from lymphomatoid papulosis&#46; The entities are also difficult to differentiate histologically&#44; unless abundant plasma cells and spirochetes are observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;83&#44;84</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Persistent Arthropod Bite Reaction</span><p id="par0170" class="elsevierStylePara elsevierViewall">Nodular scabies is the paradigm of persistent arthropod bite reaction&#44; although this can be caused by arthropods other than the scabies mite&#46; A delayed hypersensitivity reaction to a component of the mite has been implicated in the pathogenesis of the reaction&#44; although it is rarely identified in lesions&#46; Clinically&#44; arthropod bite reaction presents as reddish papules or persistent pruritic nodules&#44; despite adequate treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Histologically&#44; nodular scabies may simulate mycosis fungoides&#44; lymphomatoid papulosis&#44; Hodgkin lymphoma&#44; and in some cases&#44; cutaneous B-cell lymphoma&#46; The most frequent finding is a dense perivascular superficial and deep lymphoid infiltrate with predominant T cells&#44; which are frequently CD30<span class="elsevierStyleSup">&#43;</span>&#44; together with plasma cells&#44; eosinophils&#44; and prominent vessels&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;12&#44;36&#44;85&#44;86</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Actinic Reticuloid</span><p id="par0180" class="elsevierStylePara elsevierViewall">Actinic reticuloid is a chronic photodermatitis that tends to affect elderly patients&#44; and men in particular&#46; It is characterized by extreme photosensitivity across a wide spectrum of UV radiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;43&#44;87</span></a> Its pathogenesis remains unclear&#44; although it has been proposed that a normal component of skin might become antigenic following alterations induced by a photoallergic reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib1160"><span class="elsevierStyleSup">88&#44;89</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In its early phases&#44; actinic reticuloid presents as a highly pruritic eczematous dermatitis&#59; there is a tendency towards localized lichenification in sun-exposed areas that may then spread to other areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;88</span></a> Histology reveals a mixed perivascular superficial or deep infiltrate that may include some atypical mononuclear cells&#46; Actinic reticuloid can form a band-like pattern with lymphocytic exocytosis&#44; simulating mycosis fungoides&#44; or a more diffuse pattern&#44; simulating peripheral T-cell lymphoma&#46; The CD4&#47;CD8 ratio&#44; however&#44; is lower in the case of actinic reticuloid&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;43&#44;88</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">As the condition progresses&#44; patients may develop erythroderma&#44; enlarged lymph nodes&#44; ectropion and up to 10&#37; of S&#233;zary cells in peripheral blood&#44; complicating the differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;90&#8211;92</span></a> Unlike mycosis fungoides and S&#233;zary syndrome&#44; sensitivity to UV-B&#44; UV-A&#44; and even visible light is very high and can exacerbate the condition&#46;<a class="elsevierStyleCrossRef" href="#bib1160"><span class="elsevierStyleSup">88</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Actinic reticuloid is a chronic condition that does not tend to resolve spontaneously&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;93</span></a> Sun-protection measures are essential&#44; as is avoidance of implicated allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lichen Sclerosus</span><p id="par0200" class="elsevierStylePara elsevierViewall">Genital lichen sclerosus&#44; particularly in its early phases&#44; has histologic features that require consideration of mycosis fungoides in the differential diagnosis&#46; Lesions show a dense band-like lymphoid infiltrate in the superficial dermis and marked epidermotropism&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;94</span></a> To confuse matters even further&#44; gene rearrangement studies reveal a clonal pattern in a considerable number of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib1195"><span class="elsevierStyleSup">95&#44;96</span></a> Cellular atypia is not generally seen in the infiltrate in lichen sclerosus&#44; and intraepidermal lymphocytes tend to be located in the lower part of the epidermis&#44; without pagetoid spread&#59; interface changes are also common&#46;<a class="elsevierStyleCrossRef" href="#bib1190"><span class="elsevierStyleSup">94</span></a> It is essential to contrast clinical and pathologic findings&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Lichen Aureus</span><p id="par0205" class="elsevierStylePara elsevierViewall">Lichen aureus also has histologic features that can be confused with mycosis fungoides&#44; and in some cases&#44; there may be molecular evidence of clonality&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a> Again&#44; it is important to carefully correlate clinical and pathologic findings&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Solitary T-Cell Pseudolymphoma</span><p id="par0210" class="elsevierStylePara elsevierViewall">Solitary T-cell pseudolymphoma is one of the most controversial variants of pseudolymphoma&#46; With histologic features similar to those of mycosis fungoides and occasional monoclonality&#44; this entity can present as superficial lesions on the breasts of adult women that resemble lichenoid keratosis lesions&#46; In other cases&#44; it appears as solitary nodular lesions with histologic findings similar to those of small- to-medium-sized pleomorphic T-cell lymphoma&#46; It follows an indolent course and excision is curative&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;97&#44;98</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Lichenoid Keratosis</span><p id="par0215" class="elsevierStylePara elsevierViewall">Lichenoid keratosis is a benign epithelial tumor related to seborrheic keratosis and lentigines that affects elderly patients&#46; It appears as small scaling plaques normally located on the trunk&#46; Histologically&#44; the findings can simulate those of mycosis fungoides&#44; with a dense band-like lymphocytic infiltrate with a certain degree of epidermotropism and occasional monoclonality&#46; Clinical-pathologic correlation is essential&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;99&#8211;101</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Lymphomatoid Contact Dermatitis</span><p id="par0220" class="elsevierStylePara elsevierViewall">Described for the first time by Orbaneja et al&#46;<a class="elsevierStyleCrossRef" href="#bib1230"><span class="elsevierStyleSup">102</span></a> in 1976&#44; lymphomatoid contact dermatitis has similar clinical and histopathologic features to mycosis fungoides&#46; It presents as pruritic erythematous plaques&#44; with an oscillating course&#44; and is more common in middle-aged men&#46;<a class="elsevierStyleCrossRefs" href="#bib1230"><span class="elsevierStyleSup">102&#8211;104</span></a> Histology shows a band-like T cell&#8211;predominant infiltrate component and epidermotropism &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; However&#44; in the epidermis there may be spongiosis or microvesiculation&#59; cellular atypia is very low and there is no evidence of Pautrier microabscesses&#44; although it is not uncommon to see small collections of keratinocytes intermixed with Langerhans cells and some lymphocytes that are frequently confused with keratinocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; TCR rearrangement studies generally show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;94&#44;103&#44;104</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the allergens that have been implicated in lymphomatoid contact dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib1230"><span class="elsevierStyleSup">102&#44;105&#8211;115</span></a> Patch tests show sensitization<a class="elsevierStyleCrossRef" href="#bib1235"><span class="elsevierStyleSup">103</span></a> and the condition resolves with avoidance of exposure to causative allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Atypical CD8<span class="elsevierStyleSup">&#43;</span> Lymphoid Proliferation in Patients With Human Immunodeficiency Virus</span><p id="par0230" class="elsevierStylePara elsevierViewall">Atypical CD8<span class="elsevierStyleSup">&#43;</span> lymphoid proliferation is a polyclonal lymphoproliferative disorder with an apparently reactive nature that is clinically and histologically similar to T-cell lymphoma and affects individuals with human immunodeficiency virus infection&#44; particularly when they are severely immunocompromised&#46; Its pathogenesis is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib1300"><span class="elsevierStyleSup">116</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Clinically&#44; it presents as a generalized pruritic rash frequently associated with pigment changes &#40;hypopigmentation or hyperpigmentation&#41; and lichenification&#46; Lymphadenopathy&#44; splenomegaly&#44; eosinophilia&#44; and&#44; on occasions&#44; circulating S&#233;zary cells have also been described&#46;<a class="elsevierStyleCrossRefs" href="#bib1300"><span class="elsevierStyleSup">116&#8211;118</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The histologic features resemble those of mycosis fungoides&#44; but there is a predominance of CD8<span class="elsevierStyleSup">&#43;</span> lymphocytes&#46; Clonality studies are negative&#46;<a class="elsevierStyleCrossRefs" href="#bib1300"><span class="elsevierStyleSup">116&#44;119&#8211;121</span></a></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">CD30<span class="elsevierStyleSup">&#43;</span> T-Cell Pseudolymphoma</span><p id="par0245" class="elsevierStylePara elsevierViewall">The presence of large atypical CD30<span class="elsevierStyleSup">&#43;</span> T cells has been described in numerous reactive skin disorders in recent years &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In these pseudolymphomas&#44; CD30<span class="elsevierStyleSup">&#43;</span> cells do not form clusters but are rather distributed throughout the infiltrate&#46; Rearrangement studies show a polyclonal pattern&#46; Histology frequently shows evidence of the underlying condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;122</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Immunoglobulin G4&#8211;Related Sclerosing Disease</span><p id="par0250" class="elsevierStylePara elsevierViewall">Immunoglobulin &#40;Ig&#41; G4-related sclerosing disease is characterized by a lymphoplasmacytic infiltrate featuring IgG4<span class="elsevierStyleSup">&#43;</span> plasma cells&#44; together with sclerotic changes and elevated IgG4 serum levels &#40;&#62;135<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib1360"><span class="elsevierStyleSup">128</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Skin involvement is rare&#44; but it can occur in isolation and without elevated serum IgG4 titers&#46; IgG4-related sclerosing disease presents as plaques or as solitary or multiple nodules on the head and&#47;or extremities of middle-aged&#44; predominantly male&#44; adults&#46;<a class="elsevierStyleCrossRefs" href="#bib1365"><span class="elsevierStyleSup">129&#8211;132</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Histology shows a mixed inflammatory infiltrate immersed in a sclerotic stroma in the dermis&#44; and occasionally in the subcutaneous tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;128&#44;130</span></a> An IgG4 to total IgG ratio of above 40&#37; is highly suggestive of IgG4-related sclerosing disease&#46;<a class="elsevierStyleCrossRef" href="#bib1360"><span class="elsevierStyleSup">128</span></a></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Annular Lichenoid Dermatitis</span><p id="par0265" class="elsevierStylePara elsevierViewall">Annular lichenoid dermatitis is an entity of unknown pathogenesis&#44; initially described in children&#44; that shares many histologic and immunophenotypic characteristics with mycosis fungoides&#46; It presents as solitary or multiple asymptomatic reddish-brown annular plaques with raised borders on the trunk&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Histologic examination shows a band-like CD8<span class="elsevierStyleSup">&#43;</span>-predominant lymphocytic infiltrate&#44; vacuolar degeneration at the dermal-epidermal junction&#44; and necrotic keratinocytes at the tips of the rete ridges&#46; Marked epidermotropism&#44; Pautrier microabscesses&#44; and fibrosis in the papillary dermis are not observed&#46; Monoclonality is shown to be absent by rearrangement studies&#46;<a class="elsevierStyleCrossRefs" href="#bib1385"><span class="elsevierStyleSup">133&#8211;135</span></a></p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Palpable Migratory Arciform Erythema</span><p id="par0275" class="elsevierStylePara elsevierViewall">Palpable migratory arciform erythema is an uncommon entity that presents with erythematous annular plaques located predominantly on the trunk with a centrifugal distribution&#59; the lesions tend to disappear within days or weeks&#46; Histologically there is a perivascular and periadnexal CD4<span class="elsevierStyleSup">&#43;</span>-predominant lymphocytic infiltrate&#44; without epidermal involvement&#44; plasma cells&#44; or interstitial mucin&#46; A polyclonal pattern is detected by gene rearrangement studies in most cases&#46;<a class="elsevierStyleCrossRefs" href="#bib1400"><span class="elsevierStyleSup">136&#44;137</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Other Cutaneous Pseudolymphomas</span><p id="par0280" class="elsevierStylePara elsevierViewall">Other cutaneous pseudolymphomas can also simulate cutaneous lymphomas clinically and&#47;or histologically&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">In the inflammatory phase of vitiligo&#44; which is characterized by erythematous&#44; scaling plaques rather than achromic patches&#44; histology can reveal a dense band-like lichenoid infiltrate with lymphocytic exocytosis simulating mycosis fungoides in the lower part of the epidermis&#46; Most of the cells are CD8<span class="elsevierStyleSup">&#43;</span>&#46; Follow-up is essential&#46;<a class="elsevierStyleCrossRef" href="#bib1410"><span class="elsevierStyleSup">138</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">There have also been reports of pseudolymphomas in relation to herpes simplex and herpes zoster infections that can mimic T-cell or B-cell lymphomas or CD30<span class="elsevierStyleSup">&#43;</span> lymphoproliferative diseases&#46;<a class="elsevierStyleCrossRef" href="#bib1415"><span class="elsevierStyleSup">139</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">Atypical cells have also been described in cases of chronic discoid lupus erythematosus&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a> Jessner lymphocytic infiltrate of the skin can also be histologically confused with B-cell lymphoma&#46; Polyclonal infiltrates and CD123<span class="elsevierStyleSup">&#43;</span> plasmacytoid monocytes can help to distinguish between these disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;140</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">The true nature of pityriasis lichenoides et varioliformis acuta &#40;PLEVA&#41; is still a matter of debate&#46; PLEVA is a generally benign condition and is probably a reactive disorder with an infectious or inflammatory origin&#46;<a class="elsevierStyleCrossRefs" href="#bib1425"><span class="elsevierStyleSup">141&#8211;143</span></a> However&#44; there have been reports of monoclonal rearrangement<a class="elsevierStyleCrossRef" href="#bib1425"><span class="elsevierStyleSup">141</span></a> and&#44; at least in the febrile ulceronecrotic form&#44; an association with cytotoxic cutaneous lymphoma has been considered&#46; The 2 entities have overlapping clinical and histologic findings&#44; although infiltrates are not as dense or as deep in PLEVA&#44; and cellular atypia is also less pronounced&#46;<a class="elsevierStyleCrossRef" href="#bib1440"><span class="elsevierStyleSup">144</span></a> Follow-up is particularly important in PLEVA&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of Interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        4 => array:2 [
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          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Lupus Erythematosus Panniculitis"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Pseudolymphoma in Tattoos"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Pseudolymphoma at the Site of Vaccination"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Lymphocytoma Cutis"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Pseudolymphoma in Acrodermatitis Chronica Atrophicans Lesions"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Pseudolymphomatous Folliculitis"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Lymphomatoid Drug Reaction"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Morphea"
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        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Acral Pseudolymphomatous Angiokeratoma&#47;Small Papular Pseudolymphoma"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "T Cell&#8211;Rich Angiomatoid Polypoid Pseudolymphoma"
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        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Pretibial Lymphoplasmacytic Plaque in Children"
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        16 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Secondary Syphilis"
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        17 => array:2 [
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          "titulo" => "Persistent Arthropod Bite Reaction"
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        18 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Actinic Reticuloid"
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        19 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Lichen Sclerosus"
        ]
        20 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Lichen Aureus"
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        21 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Solitary T-Cell Pseudolymphoma"
        ]
        22 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Lichenoid Keratosis"
        ]
        23 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Lymphomatoid Contact Dermatitis"
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        24 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Atypical CD8 Lymphoid Proliferation in Patients With Human Immunodeficiency Virus"
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        25 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "CD30 T-Cell Pseudolymphoma"
        ]
        26 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Immunoglobulin G4&#8211;Related Sclerosing Disease"
        ]
        27 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Annular Lichenoid Dermatitis"
        ]
        28 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Palpable Migratory Arciform Erythema"
        ]
        29 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Other Cutaneous Pseudolymphomas"
        ]
        30 => array:2 [
          "identificador" => "sec0135"
          "titulo" => "Conflicts of Interest"
        ]
        31 => array:2 [
          "identificador" => "xack277332"
          "titulo" => "Acknowledgments"
        ]
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          "titulo" => "References"
        ]
      ]
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    "fechaRecibido" => "2015-12-21"
    "fechaAceptado" => "2016-05-01"
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            0 => "Pseudolymphoma"
            1 => "Skin"
            2 => "Cutaneous lymphoid hyperplasia"
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          "palabras" => array:3 [
            0 => "Pseudolinfoma"
            1 => "Piel"
            2 => "Hiperplasia linfoide cut&#225;nea"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The term <span class="elsevierStyleItalic">cutaneous pseudolymphoma</span> refers to benign reactive lymphoid proliferations in the skin that simulate cutaneous lymphomas&#46; It is a purely descriptive term that encompasses various reactive conditions with a varied etiology&#44; pathogenesis&#44; clinical presentation&#44; histology&#44; and behavior&#46; We present a review of the different types of cutaneous pseudolymphoma&#46; To reach a correct diagnosis&#44; it is necessary to contrast clinical&#44; histologic&#44; immunophenotypic&#44; and molecular findings&#46; Even with these data&#44; in some cases only the clinical course will confirm the diagnosis&#44; making follow-up essential&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El t&#233;rmino pseudolinfoma cut&#225;neo designa proliferaciones linfoides cut&#225;neas benignas de naturaleza reactiva que simulan linfomas cut&#225;neos&#46; Se trata de un t&#233;rmino puramente descriptivo que engloba diferentes entidades reactivas&#44; con diversa etiolog&#237;a&#44; patog&#233;nesis&#44; presentaci&#243;n cl&#237;nica&#44; histolog&#237;a y comportamiento&#46; En el presente art&#237;culo revisaremos los distintos tipos de pseudolinfoma cut&#225;neo&#46; Como veremos&#44; para llegar al correcto diagn&#243;stico de los mismos ser&#225; preciso en cada caso la integraci&#243;n de los datos cl&#237;nicos con los histopatol&#243;gicos&#44; inmunofenot&#237;picos y moleculares&#46; Incluso entonces&#44; en ocasiones solo la evoluci&#243;n confirmar&#225; el diagn&#243;stico&#44; por lo que el seguimiento ser&#225; esencial&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Romero-P&#233;rez D&#44; Blanes Mart&#237;nez M&#44; Encabo-Dur&#225;n B&#46; Pseudolinfomas cut&#225;neos&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;640&#8211;651&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lymphoid follicles in the subcutaneous tissue separated by areas of fibrosis in this vaccination-induced pseudolymphoma &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>10&#41;&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histiocytes with basophilic granular cytoplasm corresponding to the aluminum component of a vaccine&#44; intermixed with lymphocytes&#44; together with eosinophils and plasma cells &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lymphocytoma cutis&#46; Solitary lesion on the back&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Histologic image of the lymphocytoma cutis shown in <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#46; Dense mixed dermal infiltrate&#46; Note the merging germinal centers devoid of the mantel zone&#44; simulating a B-cell lymphoma &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lymphomatoid contact dermatitis&#46; In this patient sensitized to methylchloroisothiazolinone and colophony&#44; histology showed a band-like lymphocytic infiltrate and in some areas without spongiosis&#44; clusters in the epidermis reminiscent of Pautrier microabscesses&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lupus erythematosus panniculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma in tattoos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma at the site of vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphocytoma cutis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma in acrodermatitis chronica atrophicans lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphomatous folliculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphomatoid drug reaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morphea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acral pseudolymphomatous angiokeratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T cell&#8211;rich angiomatoid polypoid pseudolymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pretibial lymphoplasmacytic plaque&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent arthropod bite reaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actinic reticuloid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen sclerosus et atrophicus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen aureus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Solitary T-cell pseudolymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichenoid keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphomatoid contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atypical lymphoid proliferation in patients with human immunodeficiency virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD30<span class="elsevierStyleSup">&#43;</span> pseudolymphomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunoglobulin G4-related disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Annular lichenoid dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palpable migratory arciform erythema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other cutaneous pseudolymphomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cutaneous Pseudolymphoma&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACE&#44; angiotensin-converting enzyme&#59; NSAIDs&#44; nonsteroidal anti-inflammatory drugs&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Ploysangam et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">36</span></a> Naciri Bennani et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">51</span></a> Imafuku et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0980"><span class="elsevierStyleSup">52</span></a> Fukamachi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0985"><span class="elsevierStyleSup">53</span></a> Guis et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0990"><span class="elsevierStyleSup">54</span></a> Stavrianeas et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0995"><span class="elsevierStyleSup">55</span></a> Welsh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1000"><span class="elsevierStyleSup">56</span></a> Kitagawa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1005"><span class="elsevierStyleSup">57</span></a> Macisaac et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1010"><span class="elsevierStyleSup">58</span></a> Kim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1015"><span class="elsevierStyleSup">59</span></a> Foley et al&#46;<a class="elsevierStyleCrossRef" href="#bib1020"><span class="elsevierStyleSup">60</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anticonvulsants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phenytoin&#44; carbamazepine&#44; mephenytoin&#44; trimethadione&#44; phenobarbital&#44; primidone&#44; butabarbital&#44; methsuximide&#44; phensuximide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antipsychotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chlorpromazine&#44; thioridazine&#44; promethazine&#44; methylphenidate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antihypertensives</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACE inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril&#44; enalapril&#44; benazepril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#946;-Blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atenolol&#44; labetalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Calcium channel blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Verapamil&#44; diltiazem&#44; benidipine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Moduretic&#44; hydrochlorothiazide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cytotoxic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ciclosporin&#44; methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Rheumatology drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gold&#44; salicylates&#44; phenacetin&#44; D-penicillamine&#44; allopurinol&#44; NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antibiotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penicillin&#44; dapsone&#44; nitrofurantoin&#44; vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antidepressants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fluoxetine&#44; doxepin&#44; depramine&#44; amitriptyline&#44; lithium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anxiolytics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Benzodiazepines &#40;clonazepam&#44; lorazepam&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antihistamines</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diphenhydramine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">H2 antihistamines</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cimetidine&#44; ranitidine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antiarrhythmics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Procainamide&#44; mexiletine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Topical agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menthol&#44; eugenol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex hormones</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estrogens&#44; progesterone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lipid-lowering drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lovastatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Biologics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adalimumab&#44; infliximab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lornoxicam&#44; zoledronic acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Drugs Associated With Pseudolymphomatous Cutaneous Reactions&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Orbaneja et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1230"><span class="elsevierStyleSup">102</span></a> Marli&#232;re et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1245"><span class="elsevierStyleSup">105</span></a> Wall et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1250"><span class="elsevierStyleSup">106</span></a> Schena et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1255"><span class="elsevierStyleSup">107</span></a> Danese et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1260"><span class="elsevierStyleSup">108</span></a> Calzavara-Pinton et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1265"><span class="elsevierStyleSup">109</span></a> Fleming et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1270"><span class="elsevierStyleSup">110</span></a> Park et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1275"><span class="elsevierStyleSup">111</span></a> Komatsu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1280"><span class="elsevierStyleSup">112</span></a> Pely et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1285"><span class="elsevierStyleSup">113</span></a> Millican et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1290"><span class="elsevierStyleSup">114</span></a> Mendese et al&#46;<a class="elsevierStyleCrossRef" href="#bib1295"><span class="elsevierStyleSup">115</span></a></p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Phosphorus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N<span class="elsevierStyleItalic">-</span>Isopropyl<span class="elsevierStyleItalic">-</span>N<span class="elsevierStyleItalic">-</span>phenyl<span class="elsevierStyleItalic">-</span>4<span class="elsevierStyleItalic">-</span>phenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ethylenediamine dihydrochloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Napthen cobalt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nickel sulfate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paraphenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gold sodium thiosulfate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Zinc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Squaric acid dibutylester&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Methylchloroisothiazolinone&#47;methylisothiazolinone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Allergens Implicated in Lymphomatoid Contact Dermatitis&#46;</p>"
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                      "titulo" => "Cutaneous MALT-lymphoma&#58; From cutaneous immunocytoma and pseudolymphoma to the current &#40;and future&#41; conceptions"
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Review
Cutaneous Pseudolymphomas
Pseudolinfomas cutáneos
D. Romero-Pérez, M. Blanes Martínez
Autor para correspondencia
blanes_marmar@gva.es

Corresponding author.
, B. Encabo-Durán
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous pseudolymphomas are benign reactive lymphoid proliferations that simulate cutaneous lymphomas clinically&#44; histologically&#44; or both clinically and histologically&#46;<a class="elsevierStyleCrossRefs" href="#bib0725"><span class="elsevierStyleSup">1&#8211;6</span></a> The concept was described for the first time in 1891 by Kaposi under the name <span class="elsevierStyleItalic">sarcomatosis cutis</span>&#46; Since then&#44; these proliferations have received many names and the initial descriptions all corresponded to B-cell pseudolymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">4&#44;5&#44;7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Traditionally&#44; cutaneous pseudolymphomas have been classified according to their histologic and immunophenotypic characteristics or rather in relation to the lymphoma they simulate&#46; In other words&#44; they are categorized as cutaneous B-cell pseudolymphomas or cutaneous T-cell pseudolymphomas&#44; depending on the predominant lymphocytic component&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">9</span></a> While the distinction is frequently artificial&#44; this classification system is still the widely used system for categorizing pseudolymphomas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The list of cutaneous pseudolymphomas has grown in recent years with the inclusion of multiple reactive conditions with histopathologic features mimicking those of true lymphomas&#46; It is also noteworthy that several entities that were originally considered to be cutaneous pseudolymphomas have since been reclassified as low-grade lymphomas based on clinical and pathologic findings&#44; molecular biology studies&#44; and follow-up data&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Epidemiological data on cutaneous pseudolymphomas are scarce&#44; although B-cell pseudolymphomas appear to be more common than their T-cell counterparts&#44; and they are also more common in female patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">4&#44;5&#44;10</span></a> Cutaneous pseudolymphoma generally affects adults&#44; although it can occur at any age&#46; No familial cases have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The proliferation of skin-associated lymphoid tissue &#40;SALT&#41;&#44; the cutaneous analog of mucosa-associated lymphoid tissue &#40;MALT&#41;&#44; following antigenic stimulation has been proposed as a contributory factor in the pathogenesis of cutaneous pseudolymphoma &#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">11</span></a> Accordingly&#44; cutaneous pseudolymphoma could potentially progress to a true cutaneous lymphoma with permanent antigenic stimulation&#44; as occurs in the gastric mucosa in the presence of persistent <span class="elsevierStyleItalic">Helicobacter pylori</span> infection&#46;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">12</span></a> However&#44; while there have been some reports of progression to cutaneous lymphoma&#44;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">13&#8211;17</span></a> true progression from a correctly diagnosed pseudolymphoma is very rare&#44; if not impossible&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To diagnose cutaneous pseudolymphoma it is necessary to contrast clinical and histologic findings&#44; with assessment of the architecture and composition of the inflammatory infiltrate&#44; and to complement these findings with immunohistochemistry and gene rearrangement studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;18&#44;19</span></a> These clonality studies generally reveal a polyclonal pattern&#46; Nevertheless&#44; it is not always possible to demonstrate clonality in true lymphomas&#44; and certain pseudolymphomas have monoclonal B-cell and T-cell populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">5&#44;8&#44;20&#8211;26</span></a> Accordingly&#44; although gene arrangement studies are useful&#44; their results must be interpreted with caution and within the context of the data available&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the rest of this paper we will describe the main types of cutaneous pseudolymphoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Lupus Erythematosus Panniculitis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lupus with subcutaneous involvement&#44; a condition known as lupus erythematosus panniculitis&#44; can raise clinical and particularly histologic suspicions of panniculitis-like T-cell lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;27</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Lupus erythematosus panniculitis presents as plaques or subcutaneous nodules in areas rarely affected by other forms of panniculitis&#44; such as the face&#44; the shoulders&#44; and the proximal aspect of the arms&#46; Antinuclear antibodies and other diagnostic criteria for systemic lupus erythematosus may be absent&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologic examination shows a predominantly lobular panniculitis with dense lymphoid infiltrates in the deep dermis and the hypodermis&#44; along with wide fibrous septae on occasions&#46; The infiltrate is mixed&#44; with abundant B cells&#44; plasma cells&#44; and clusters of plasmacytoid dendritic cells&#44; frequently forming reactive germinal centers&#46; The dermal-epidermal junction may show the characteristic interface dermatitis associated with the underlying connective tissue disease&#44; and this is a key finding for the differential diagnosis&#46; In lupus erythematosus panniculitis&#44; unlike in panniculitis-like T-cell lymphoma&#44; histology does not show cytophagocytosis or adipocyte rimming &#40;atypical lymphoid cells surrounding the adipocytes&#41;&#46; T-cell receptor &#40;<span class="elsevierStyleItalic">TCR</span>&#41; gene rearrangement will show a polyclonal pattern&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;27</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histologic features of panniculitis-like T-cell lymphoma and lupus erythematosus panniculitis may&#44; albeit rarely&#44; overlap&#46; In one study of 83 patients with panniculitis-like T-cell lymphoma&#44; Willemze et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">28</span></a> observed abundant plasma cells interspersed with CD4<span class="elsevierStyleSup">&#43;</span> T cells in 4 patients who also had lupus erythematosus&#44; leading to an initial misdiagnosis of lupus erythematous panniculitis&#46; The presence of cellular atypia together with a loss of pan-T-cell markers and&#47;or clonal TCR-&#947; rearrangement was key to establishing a correct diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pseudolymphoma in Tattoos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Although uncommon&#44; pseudolymphomatous reactions to tattoo ink can occur&#44; and a variable latency period has been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">29&#44;30</span></a> Red ink is the most common ink involved in these reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">30</span></a> Tattoo ink&#8211;related pseudolymphoma presents as subcutaneous nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Histologic examination shows a dense diffuse dermal infiltrate with perivascular and periadnexal accentuation composed mainly of small lymphocytes &#40;most often T cells but there may also be B cells or a mixture&#41; and macrophages&#46; Additional findings include eosinophils&#44; plasma cells&#44; histiocytes&#44; and giant multinucleated cells&#46; These cells may form lymphoid follicles with germinal centers or patterns similar to those seen in mycosis fungoides&#46; Spongiosis&#44; exocytosis&#44; and basal vacuolar degeneration may also be observed in the epidermis&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">29&#44;30</span></a> The presence of macrophages phagocytizing the pigment is a key diagnostic clue&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pseudolymphoma at the Site of Vaccination</span><p id="par0070" class="elsevierStylePara elsevierViewall">An intense inflammatory response simulating cutaneous lymphoma can also occur at vaccination sites as the result of a delayed hypersensitivity reaction to vaccine components&#46; This reaction is particularly seen in vaccines containing aluminum&#44; as this metal contributes to the delayed absorption of other components&#44; thereby prolonging the antigen stimulus&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;31</span></a> It presents as papules or superficial or deep erythematous nodules&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;32</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The histologic pattern may be lichenoid&#44; simulating mycosis fungoides&#44; or nodular&#44; simulating follicle center lymphoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this second case&#44; however&#44; bcl-6<span class="elsevierStyleSup">&#43;</span> cells will not be observed outside the reactive germinal centers&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;33</span></a> Clusters of CD30<span class="elsevierStyleSup">&#43;</span> cells may occasionally be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0885"><span class="elsevierStyleSup">33</span></a> When aluminum is involved&#44; the histiocytes in the infiltrate&#44; which may be solitary or arranged in clusters forming epithelioid granulomas&#44; typically have abundant granular and basophilic cytoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; corresponding to intracellular aluminum deposits&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Lymphocytoma Cutis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Lymphocytoma cutis was first described by Spiegler in 1894&#46; It is the prototype of cutaneous B-cell pseudolymphoma and perhaps the most common variant&#46; It represents an exaggerated local immune response to diverse stimuli&#44; the most widely described of which are arthropod bites&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;32&#8211;37</span></a> One of the most classic associations is with the spirochete <span class="elsevierStyleItalic">Borrelia burgdorferi</span> following a bite from a <span class="elsevierStyleItalic">Ixodes</span> tick&#46;<a class="elsevierStyleCrossRefs" href="#bib0830"><span class="elsevierStyleSup">22&#44;38</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Lymphocytoma cutis typically presents as a solitary reddish nodule &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; or less frequently as plaques or crops of papules&#46; The face and neck are the most common sites of involvement&#46; Lesions on the earlobe&#44; nipples&#44; or scrotum are highly characteristic of <span class="elsevierStyleItalic">B&#160;burgdorferi</span>&#8211;associated lymphocytoma cutis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;38&#8211;40</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Miliarial-type lesions have also been described&#44; but less frequently&#46; These present as multiple&#44; symmetric&#44; monomorphous translucent micropapules on the head and neck and they can be asymptomatic or slightly pruritic&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;41&#44;42</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Histology reveals a dense nodular lymphoid infiltrate in the dermis&#44; with germinal centers that characteristically lack a mantle zone and may merge&#46; Although the infiltrate in pseudolymphomas tends to be top heavy &#40;i&#46;e&#46;&#44; more pronounced in the superficial dermis&#41; rather than bottom heavy like in lymphomas&#44; in <span class="elsevierStyleItalic">B&#160;burgdorferi</span>&#8211;associated lymphocytoma cutis&#44; infiltrates are often found throughout the dermis and even in the superficial layers of the subcutaneous tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The infiltrate is formed by plasma cells&#44; eosinophils&#44; abundant reactive T cells&#44; and tingible body macrophages &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; This heterogeneity is another factor to take into account when distinguishing cutaneous pseudolymphomas from true lymphomas&#44; as these tend to have a more uniform infiltrate&#46; The predominant immunophenotype is a germinal center B-cell type&#44; with positive staining for CD20&#44; CD10&#44; and bcl-6&#44; and negative staining for bcl-2&#46; The germinal centers tend to have a very high proliferative index&#44; but unlike in true cutaneous lymphomas&#44; cellular atypia and preservation of adnexal structures are not observed&#46; Rearrangement analysis usually&#44; but not always&#44; shows a polyclonal pattern&#46; Assessment of clonality in more than 1 lesion is very useful for differentiating pseudolymphomas and lymphomas in patients with several lesions&#46; Detection of the same clone in 2 lesions or in the same lesion at different stages of development would point to a diagnosis of lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;39&#44;43</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pseudolymphoma in Acrodermatitis Chronica Atrophicans Lesions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Pseudolymphoma has been described in the lesions of patients with acrodermatitis chronica atrophicans&#44; which is a delayed cutaneous manifestation of <span class="elsevierStyleItalic">B burgdorferi</span> infection&#46; Histologically&#44; lesions can display 2 patterns&#58; one simulating mycosis fungoides and the other &#40;less frequent&#41; one simulating cutaneous B-cell lymphoma&#46; The rearrangement study shows a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0940"><span class="elsevierStyleSup">44&#44;45</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pseudolymphomatous Folliculitis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Pseudolymphomatous folliculitis is a cutaneous pseudolymphoma characterized by the presence of hyperplastic hair follicles together with a lymphoid infiltrate that can mimic cutaneous lymphoma&#46; It presents with a single or&#44; less frequently&#44; several dome-shaped or nodular lesions on the face&#44; scalp&#44; or trunk&#46;<a class="elsevierStyleCrossRefs" href="#bib0780"><span class="elsevierStyleSup">12&#44;46</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Histologically&#44; pseudolymphomatous folliculitis can simulate small-to-medium-sized pleomorphic T-cell lymphoma&#44; follicle center B-cell lymphoma&#44; or even folliculotropic mycosis fungoides&#46; A dense lymphocytic infiltrate is located predominantly around the hair follicles&#44; which show hyperplastic changes and thickened walls&#46; Clusters of perifollicular S100<span class="elsevierStyleSup">&#43;</span> and CD1A<span class="elsevierStyleSup">&#43;</span> histiocytes may occasionally be seen&#46; Rearrangement studies show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;12&#44;46&#8211;50</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Lymphomatoid Drug Reaction</span><p id="par0120" class="elsevierStylePara elsevierViewall">Numerous drugs can induce cutaneous lymphoid infiltrates that resemble lymphoma clinically&#44; histologically&#44; or both clinically and histologically&#46; The most frequently implicated drugs are anticonvulsants and antihypertensives&#44; but others have been described &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Clinically&#44; lymphomatoid drug reactions present as generalized papules&#44; plaques&#44; or nodules&#44; or even erythroderma&#44; sometimes with accentuation in sun-exposed areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;61</span></a> Lesions typically appear 2 to 8 weeks after the introduction of the offending drug&#44; but later onset has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;42&#44;62</span></a> The skin lesions may be accompanied by enlarged lymph nodes&#44; fever&#44; and less frequently hepatosplenomegaly&#44; joint pain&#44; and diverse blood test alterations including elevated liver enzymes and eosinophilia&#44; particularly in cases due to anticonvulsants&#46;<a class="elsevierStyleCrossRefs" href="#bib1025"><span class="elsevierStyleSup">61&#44;63</span></a> Circulating S&#233;zary cells may occasionally be detected&#46;<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">36</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Histologic findings in lymphomatoid drug reaction include a band-like T&#160;cell&#8211;predominant infiltrate with epidermal spongiosis and exocytosis&#44; simulating mycosis fungoides&#46; On other occasions&#44; there may be a nodular or diffuse B-cell pattern with formation of germinal centers&#44; simulating follicle center or marginal zone B-cell lymphoma&#46; Cellular atypia has been described in some cases&#44; as have abundant CD30<span class="elsevierStyleSup">&#43;</span> cells&#44; which can complicate diagnosis&#46; Findings suggestive of lymphomatoid drug reaction include necrotic keratinocytes&#44; red blood cell extravasation&#44; pigmentary incontinence&#44; dermal edema&#44; absence of fibrosis in the papillary dermis&#44; presence of other inflammatory cells in the infiltrate&#44; and finally&#44; negative clonality in the gene rearrangement study&#46; Lesions in sun-exposed areas can also point to a diagnosis of lymphomatoid drug reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0930"><span class="elsevierStyleSup">42&#44;43&#44;61&#44;64&#8211;68</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The condition resolves after a variable period of time on withdrawal of the drug and returns when it is reintroduced&#46;<a class="elsevierStyleCrossRefs" href="#bib0930"><span class="elsevierStyleSup">42&#44;43</span></a> There have been very rare reports of progression to true cutaneous lymphoma&#44;<a class="elsevierStyleCrossRef" href="#bib1065"><span class="elsevierStyleSup">69</span></a> and in these cases the skin lesions would not disappear after withdrawal of the drug&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Morphea</span><p id="par0140" class="elsevierStylePara elsevierViewall">Collagen involvement is often not very evident in the inflammatory phase of connective tissue disorders&#44; especially in localized scleroderma&#44; and histology may reveal dense lymphoid infiltrates simulating cutaneous lymphoma and marginal zone B-cell lymphoma in particular&#46; Plasma cells are almost always present and light chain gene rearrangement studies will show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;70&#44;71</span></a> It is essential to contrast clinical and pathologic findings in such cases&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Acral Pseudolymphomatous Angiokeratoma&#47;Small Papular Pseudolymphoma</span><p id="par0145" class="elsevierStylePara elsevierViewall">Acral pseudolymphomatous angiokeratoma&#44; which was originally described under the acronym APACHE &#40;acral pseudolymphoma angiokeratoma in children&#41;&#44; is a rare benign condition of unknown etiology and pathogenesis&#44; although some authors believe it is a hypersensitivity reaction to insect bites&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">4&#44;6&#44;72&#44;73</span></a> It is characterized by papules or clusters of asymptomatic red-purple nodules&#44; typically located at acral sites&#44; and is more common in children and adolescents&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;36&#44;72&#8211;75</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Histologic findings include a dense well-differentiated nodular B-cell and T-cell infiltrate that generally spares the adnexal structures&#44; in addition to plasma cells&#44; eosinophils&#44; and on occasions histiocytes and giant multinucleated cells&#46; A proliferation of capillary vessels may be observed&#46; The epidermis is normally spared&#44; although there have been reports of basal vacuolization&#44; exocytosis&#44; and spongiosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;72</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">T Cell&#8211;Rich Angiomatoid Polypoid Pseudolymphoma</span><p id="par0155" class="elsevierStylePara elsevierViewall">T cell&#8211;rich angiomatoid polypoid pseudolymphoma has similar histologic findings to acral pseudolymphomatous angiokeratoma&#44; but it is characterized by solitary polypoid lesions at nonacral sites&#44; with a predilection for the head and trunk&#46; It typically affects young adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;76&#44;77</span></a> Another difference between the 2 entities is that in angiomatoid polypoid pseudolymphoma&#44; there is a predominance of CD4<span class="elsevierStyleSup">&#43;</span> T cells in the infiltrate and the prominent thick-walled vessels seen in acral pseudolymphomatous angiokeratoma are absent&#46; Both entities must be distinguished from angioplasmacellular hyperplasia&#44; in which the infiltrate is much richer in plasma cells&#46;<a class="elsevierStyleCrossRefs" href="#bib1100"><span class="elsevierStyleSup">76&#8211;78</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pretibial Lymphoplasmacytic Plaque in Children</span><p id="par0160" class="elsevierStylePara elsevierViewall">Pretibial lymphoplasmacytic plaque is a benign chronic condition of unknown etiology that is probably reactive in nature&#46; It presents as red-purple asymptomatic papules or well-delimited plaques that preferentially affect the anterior surface of the tibia in children&#46; Histologically&#44; it is similar to acral pseudolymphomatous angiokeratoma&#44; although there is a much more pronounced presence of plasma cells&#44; together with lymphocytes and prominent vessels&#46; Vacuolization&#44; exocytosis&#44; and apoptotic bodies may be observed in the epidermis&#46; The gene rearrangement study shows a polyclonal pattern&#46;<a class="elsevierStyleCrossRefs" href="#bib1115"><span class="elsevierStyleSup">79&#8211;82</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Secondary Syphilis</span><p id="par0165" class="elsevierStylePara elsevierViewall">Histology of secondary syphilis lesions and less frequently of primary or tertiary syphilis lesions may occasionally reveal a lymphoplasmacytic infiltrate simulating marginal zone B-cell cutaneous lymphoma&#46; The coexistence of interface&#47;lichenoid dermatitis or granulomatous inflammation is an important diagnostic clue&#46; Rearrangement studies show a polyclonal pattern and specific immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span> confirms the presence of these organisms&#46; Lesions resolve quickly with antibiotic treatment&#46; It is also worth noting that certain cases of malignant syphilis may also feature lesions that are clinically indistinguishable from lymphomatoid papulosis&#46; The entities are also difficult to differentiate histologically&#44; unless abundant plasma cells and spirochetes are observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;83&#44;84</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Persistent Arthropod Bite Reaction</span><p id="par0170" class="elsevierStylePara elsevierViewall">Nodular scabies is the paradigm of persistent arthropod bite reaction&#44; although this can be caused by arthropods other than the scabies mite&#46; A delayed hypersensitivity reaction to a component of the mite has been implicated in the pathogenesis of the reaction&#44; although it is rarely identified in lesions&#46; Clinically&#44; arthropod bite reaction presents as reddish papules or persistent pruritic nodules&#44; despite adequate treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Histologically&#44; nodular scabies may simulate mycosis fungoides&#44; lymphomatoid papulosis&#44; Hodgkin lymphoma&#44; and in some cases&#44; cutaneous B-cell lymphoma&#46; The most frequent finding is a dense perivascular superficial and deep lymphoid infiltrate with predominant T cells&#44; which are frequently CD30<span class="elsevierStyleSup">&#43;</span>&#44; together with plasma cells&#44; eosinophils&#44; and prominent vessels&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;12&#44;36&#44;85&#44;86</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Actinic Reticuloid</span><p id="par0180" class="elsevierStylePara elsevierViewall">Actinic reticuloid is a chronic photodermatitis that tends to affect elderly patients&#44; and men in particular&#46; It is characterized by extreme photosensitivity across a wide spectrum of UV radiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;43&#44;87</span></a> Its pathogenesis remains unclear&#44; although it has been proposed that a normal component of skin might become antigenic following alterations induced by a photoallergic reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib1160"><span class="elsevierStyleSup">88&#44;89</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In its early phases&#44; actinic reticuloid presents as a highly pruritic eczematous dermatitis&#59; there is a tendency towards localized lichenification in sun-exposed areas that may then spread to other areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;88</span></a> Histology reveals a mixed perivascular superficial or deep infiltrate that may include some atypical mononuclear cells&#46; Actinic reticuloid can form a band-like pattern with lymphocytic exocytosis&#44; simulating mycosis fungoides&#44; or a more diffuse pattern&#44; simulating peripheral T-cell lymphoma&#46; The CD4&#47;CD8 ratio&#44; however&#44; is lower in the case of actinic reticuloid&#46;<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">36&#44;43&#44;88</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">As the condition progresses&#44; patients may develop erythroderma&#44; enlarged lymph nodes&#44; ectropion and up to 10&#37; of S&#233;zary cells in peripheral blood&#44; complicating the differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;36&#44;90&#8211;92</span></a> Unlike mycosis fungoides and S&#233;zary syndrome&#44; sensitivity to UV-B&#44; UV-A&#44; and even visible light is very high and can exacerbate the condition&#46;<a class="elsevierStyleCrossRef" href="#bib1160"><span class="elsevierStyleSup">88</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Actinic reticuloid is a chronic condition that does not tend to resolve spontaneously&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;93</span></a> Sun-protection measures are essential&#44; as is avoidance of implicated allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lichen Sclerosus</span><p id="par0200" class="elsevierStylePara elsevierViewall">Genital lichen sclerosus&#44; particularly in its early phases&#44; has histologic features that require consideration of mycosis fungoides in the differential diagnosis&#46; Lesions show a dense band-like lymphoid infiltrate in the superficial dermis and marked epidermotropism&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;94</span></a> To confuse matters even further&#44; gene rearrangement studies reveal a clonal pattern in a considerable number of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib1195"><span class="elsevierStyleSup">95&#44;96</span></a> Cellular atypia is not generally seen in the infiltrate in lichen sclerosus&#44; and intraepidermal lymphocytes tend to be located in the lower part of the epidermis&#44; without pagetoid spread&#59; interface changes are also common&#46;<a class="elsevierStyleCrossRef" href="#bib1190"><span class="elsevierStyleSup">94</span></a> It is essential to contrast clinical and pathologic findings&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Lichen Aureus</span><p id="par0205" class="elsevierStylePara elsevierViewall">Lichen aureus also has histologic features that can be confused with mycosis fungoides&#44; and in some cases&#44; there may be molecular evidence of clonality&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a> Again&#44; it is important to carefully correlate clinical and pathologic findings&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Solitary T-Cell Pseudolymphoma</span><p id="par0210" class="elsevierStylePara elsevierViewall">Solitary T-cell pseudolymphoma is one of the most controversial variants of pseudolymphoma&#46; With histologic features similar to those of mycosis fungoides and occasional monoclonality&#44; this entity can present as superficial lesions on the breasts of adult women that resemble lichenoid keratosis lesions&#46; In other cases&#44; it appears as solitary nodular lesions with histologic findings similar to those of small- to-medium-sized pleomorphic T-cell lymphoma&#46; It follows an indolent course and excision is curative&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;97&#44;98</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Lichenoid Keratosis</span><p id="par0215" class="elsevierStylePara elsevierViewall">Lichenoid keratosis is a benign epithelial tumor related to seborrheic keratosis and lentigines that affects elderly patients&#46; It appears as small scaling plaques normally located on the trunk&#46; Histologically&#44; the findings can simulate those of mycosis fungoides&#44; with a dense band-like lymphocytic infiltrate with a certain degree of epidermotropism and occasional monoclonality&#46; Clinical-pathologic correlation is essential&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;99&#8211;101</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Lymphomatoid Contact Dermatitis</span><p id="par0220" class="elsevierStylePara elsevierViewall">Described for the first time by Orbaneja et al&#46;<a class="elsevierStyleCrossRef" href="#bib1230"><span class="elsevierStyleSup">102</span></a> in 1976&#44; lymphomatoid contact dermatitis has similar clinical and histopathologic features to mycosis fungoides&#46; It presents as pruritic erythematous plaques&#44; with an oscillating course&#44; and is more common in middle-aged men&#46;<a class="elsevierStyleCrossRefs" href="#bib1230"><span class="elsevierStyleSup">102&#8211;104</span></a> Histology shows a band-like T cell&#8211;predominant infiltrate component and epidermotropism &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; However&#44; in the epidermis there may be spongiosis or microvesiculation&#59; cellular atypia is very low and there is no evidence of Pautrier microabscesses&#44; although it is not uncommon to see small collections of keratinocytes intermixed with Langerhans cells and some lymphocytes that are frequently confused with keratinocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; TCR rearrangement studies generally show a polyclonal infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;94&#44;103&#44;104</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the allergens that have been implicated in lymphomatoid contact dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib1230"><span class="elsevierStyleSup">102&#44;105&#8211;115</span></a> Patch tests show sensitization<a class="elsevierStyleCrossRef" href="#bib1235"><span class="elsevierStyleSup">103</span></a> and the condition resolves with avoidance of exposure to causative allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Atypical CD8<span class="elsevierStyleSup">&#43;</span> Lymphoid Proliferation in Patients With Human Immunodeficiency Virus</span><p id="par0230" class="elsevierStylePara elsevierViewall">Atypical CD8<span class="elsevierStyleSup">&#43;</span> lymphoid proliferation is a polyclonal lymphoproliferative disorder with an apparently reactive nature that is clinically and histologically similar to T-cell lymphoma and affects individuals with human immunodeficiency virus infection&#44; particularly when they are severely immunocompromised&#46; Its pathogenesis is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib1300"><span class="elsevierStyleSup">116</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Clinically&#44; it presents as a generalized pruritic rash frequently associated with pigment changes &#40;hypopigmentation or hyperpigmentation&#41; and lichenification&#46; Lymphadenopathy&#44; splenomegaly&#44; eosinophilia&#44; and&#44; on occasions&#44; circulating S&#233;zary cells have also been described&#46;<a class="elsevierStyleCrossRefs" href="#bib1300"><span class="elsevierStyleSup">116&#8211;118</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The histologic features resemble those of mycosis fungoides&#44; but there is a predominance of CD8<span class="elsevierStyleSup">&#43;</span> lymphocytes&#46; Clonality studies are negative&#46;<a class="elsevierStyleCrossRefs" href="#bib1300"><span class="elsevierStyleSup">116&#44;119&#8211;121</span></a></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">CD30<span class="elsevierStyleSup">&#43;</span> T-Cell Pseudolymphoma</span><p id="par0245" class="elsevierStylePara elsevierViewall">The presence of large atypical CD30<span class="elsevierStyleSup">&#43;</span> T cells has been described in numerous reactive skin disorders in recent years &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; In these pseudolymphomas&#44; CD30<span class="elsevierStyleSup">&#43;</span> cells do not form clusters but are rather distributed throughout the infiltrate&#46; Rearrangement studies show a polyclonal pattern&#46; Histology frequently shows evidence of the underlying condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">6&#44;122</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Immunoglobulin G4&#8211;Related Sclerosing Disease</span><p id="par0250" class="elsevierStylePara elsevierViewall">Immunoglobulin &#40;Ig&#41; G4-related sclerosing disease is characterized by a lymphoplasmacytic infiltrate featuring IgG4<span class="elsevierStyleSup">&#43;</span> plasma cells&#44; together with sclerotic changes and elevated IgG4 serum levels &#40;&#62;135<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib1360"><span class="elsevierStyleSup">128</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Skin involvement is rare&#44; but it can occur in isolation and without elevated serum IgG4 titers&#46; IgG4-related sclerosing disease presents as plaques or as solitary or multiple nodules on the head and&#47;or extremities of middle-aged&#44; predominantly male&#44; adults&#46;<a class="elsevierStyleCrossRefs" href="#bib1365"><span class="elsevierStyleSup">129&#8211;132</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Histology shows a mixed inflammatory infiltrate immersed in a sclerotic stroma in the dermis&#44; and occasionally in the subcutaneous tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">11&#44;128&#44;130</span></a> An IgG4 to total IgG ratio of above 40&#37; is highly suggestive of IgG4-related sclerosing disease&#46;<a class="elsevierStyleCrossRef" href="#bib1360"><span class="elsevierStyleSup">128</span></a></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Annular Lichenoid Dermatitis</span><p id="par0265" class="elsevierStylePara elsevierViewall">Annular lichenoid dermatitis is an entity of unknown pathogenesis&#44; initially described in children&#44; that shares many histologic and immunophenotypic characteristics with mycosis fungoides&#46; It presents as solitary or multiple asymptomatic reddish-brown annular plaques with raised borders on the trunk&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Histologic examination shows a band-like CD8<span class="elsevierStyleSup">&#43;</span>-predominant lymphocytic infiltrate&#44; vacuolar degeneration at the dermal-epidermal junction&#44; and necrotic keratinocytes at the tips of the rete ridges&#46; Marked epidermotropism&#44; Pautrier microabscesses&#44; and fibrosis in the papillary dermis are not observed&#46; Monoclonality is shown to be absent by rearrangement studies&#46;<a class="elsevierStyleCrossRefs" href="#bib1385"><span class="elsevierStyleSup">133&#8211;135</span></a></p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Palpable Migratory Arciform Erythema</span><p id="par0275" class="elsevierStylePara elsevierViewall">Palpable migratory arciform erythema is an uncommon entity that presents with erythematous annular plaques located predominantly on the trunk with a centrifugal distribution&#59; the lesions tend to disappear within days or weeks&#46; Histologically there is a perivascular and periadnexal CD4<span class="elsevierStyleSup">&#43;</span>-predominant lymphocytic infiltrate&#44; without epidermal involvement&#44; plasma cells&#44; or interstitial mucin&#46; A polyclonal pattern is detected by gene rearrangement studies in most cases&#46;<a class="elsevierStyleCrossRefs" href="#bib1400"><span class="elsevierStyleSup">136&#44;137</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Other Cutaneous Pseudolymphomas</span><p id="par0280" class="elsevierStylePara elsevierViewall">Other cutaneous pseudolymphomas can also simulate cutaneous lymphomas clinically and&#47;or histologically&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">In the inflammatory phase of vitiligo&#44; which is characterized by erythematous&#44; scaling plaques rather than achromic patches&#44; histology can reveal a dense band-like lichenoid infiltrate with lymphocytic exocytosis simulating mycosis fungoides in the lower part of the epidermis&#46; Most of the cells are CD8<span class="elsevierStyleSup">&#43;</span>&#46; Follow-up is essential&#46;<a class="elsevierStyleCrossRef" href="#bib1410"><span class="elsevierStyleSup">138</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">There have also been reports of pseudolymphomas in relation to herpes simplex and herpes zoster infections that can mimic T-cell or B-cell lymphomas or CD30<span class="elsevierStyleSup">&#43;</span> lymphoproliferative diseases&#46;<a class="elsevierStyleCrossRef" href="#bib1415"><span class="elsevierStyleSup">139</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">Atypical cells have also been described in cases of chronic discoid lupus erythematosus&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">6</span></a> Jessner lymphocytic infiltrate of the skin can also be histologically confused with B-cell lymphoma&#46; Polyclonal infiltrates and CD123<span class="elsevierStyleSup">&#43;</span> plasmacytoid monocytes can help to distinguish between these disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">43&#44;140</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">The true nature of pityriasis lichenoides et varioliformis acuta &#40;PLEVA&#41; is still a matter of debate&#46; PLEVA is a generally benign condition and is probably a reactive disorder with an infectious or inflammatory origin&#46;<a class="elsevierStyleCrossRefs" href="#bib1425"><span class="elsevierStyleSup">141&#8211;143</span></a> However&#44; there have been reports of monoclonal rearrangement<a class="elsevierStyleCrossRef" href="#bib1425"><span class="elsevierStyleSup">141</span></a> and&#44; at least in the febrile ulceronecrotic form&#44; an association with cytotoxic cutaneous lymphoma has been considered&#46; The 2 entities have overlapping clinical and histologic findings&#44; although infiltrates are not as dense or as deep in PLEVA&#44; and cellular atypia is also less pronounced&#46;<a class="elsevierStyleCrossRef" href="#bib1440"><span class="elsevierStyleSup">144</span></a> Follow-up is particularly important in PLEVA&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of Interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:33 [
        0 => array:3 [
          "identificador" => "xres826626"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
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          ]
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        1 => array:2 [
          "identificador" => "xpalclavsec822937"
          "titulo" => "Keywords"
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          "identificador" => "xres826625"
          "titulo" => "Resumen"
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            ]
          ]
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          "identificador" => "xpalclavsec822936"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Lupus Erythematosus Panniculitis"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Pseudolymphoma in Tattoos"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Pseudolymphoma at the Site of Vaccination"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Lymphocytoma Cutis"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Pseudolymphoma in Acrodermatitis Chronica Atrophicans Lesions"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Pseudolymphomatous Folliculitis"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Lymphomatoid Drug Reaction"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Morphea"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Acral Pseudolymphomatous Angiokeratoma&#47;Small Papular Pseudolymphoma"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "T Cell&#8211;Rich Angiomatoid Polypoid Pseudolymphoma"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Pretibial Lymphoplasmacytic Plaque in Children"
        ]
        16 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Secondary Syphilis"
        ]
        17 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Persistent Arthropod Bite Reaction"
        ]
        18 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Actinic Reticuloid"
        ]
        19 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Lichen Sclerosus"
        ]
        20 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Lichen Aureus"
        ]
        21 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Solitary T-Cell Pseudolymphoma"
        ]
        22 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Lichenoid Keratosis"
        ]
        23 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Lymphomatoid Contact Dermatitis"
        ]
        24 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Atypical CD8 Lymphoid Proliferation in Patients With Human Immunodeficiency Virus"
        ]
        25 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "CD30 T-Cell Pseudolymphoma"
        ]
        26 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Immunoglobulin G4&#8211;Related Sclerosing Disease"
        ]
        27 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Annular Lichenoid Dermatitis"
        ]
        28 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Palpable Migratory Arciform Erythema"
        ]
        29 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Other Cutaneous Pseudolymphomas"
        ]
        30 => array:2 [
          "identificador" => "sec0135"
          "titulo" => "Conflicts of Interest"
        ]
        31 => array:2 [
          "identificador" => "xack277332"
          "titulo" => "Acknowledgments"
        ]
        32 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-12-21"
    "fechaAceptado" => "2016-05-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec822937"
          "palabras" => array:3 [
            0 => "Pseudolymphoma"
            1 => "Skin"
            2 => "Cutaneous lymphoid hyperplasia"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec822936"
          "palabras" => array:3 [
            0 => "Pseudolinfoma"
            1 => "Piel"
            2 => "Hiperplasia linfoide cut&#225;nea"
          ]
        ]
      ]
    ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The term <span class="elsevierStyleItalic">cutaneous pseudolymphoma</span> refers to benign reactive lymphoid proliferations in the skin that simulate cutaneous lymphomas&#46; It is a purely descriptive term that encompasses various reactive conditions with a varied etiology&#44; pathogenesis&#44; clinical presentation&#44; histology&#44; and behavior&#46; We present a review of the different types of cutaneous pseudolymphoma&#46; To reach a correct diagnosis&#44; it is necessary to contrast clinical&#44; histologic&#44; immunophenotypic&#44; and molecular findings&#46; Even with these data&#44; in some cases only the clinical course will confirm the diagnosis&#44; making follow-up essential&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El t&#233;rmino pseudolinfoma cut&#225;neo designa proliferaciones linfoides cut&#225;neas benignas de naturaleza reactiva que simulan linfomas cut&#225;neos&#46; Se trata de un t&#233;rmino puramente descriptivo que engloba diferentes entidades reactivas&#44; con diversa etiolog&#237;a&#44; patog&#233;nesis&#44; presentaci&#243;n cl&#237;nica&#44; histolog&#237;a y comportamiento&#46; En el presente art&#237;culo revisaremos los distintos tipos de pseudolinfoma cut&#225;neo&#46; Como veremos&#44; para llegar al correcto diagn&#243;stico de los mismos ser&#225; preciso en cada caso la integraci&#243;n de los datos cl&#237;nicos con los histopatol&#243;gicos&#44; inmunofenot&#237;picos y moleculares&#46; Incluso entonces&#44; en ocasiones solo la evoluci&#243;n confirmar&#225; el diagn&#243;stico&#44; por lo que el seguimiento ser&#225; esencial&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Romero-P&#233;rez D&#44; Blanes Mart&#237;nez M&#44; Encabo-Dur&#225;n B&#46; Pseudolinfomas cut&#225;neos&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;640&#8211;651&#46;</p>"
      ]
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lymphoid follicles in the subcutaneous tissue separated by areas of fibrosis in this vaccination-induced pseudolymphoma &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>10&#41;&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histiocytes with basophilic granular cytoplasm corresponding to the aluminum component of a vaccine&#44; intermixed with lymphocytes&#44; together with eosinophils and plasma cells &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lymphocytoma cutis&#46; Solitary lesion on the back&#46;</p>"
        ]
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Histologic image of the lymphocytoma cutis shown in <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#46; Dense mixed dermal infiltrate&#46; Note the merging germinal centers devoid of the mantel zone&#44; simulating a B-cell lymphoma &#40;hematoxylin-eosin&#44; original magnification &#215;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lymphomatoid contact dermatitis&#46; In this patient sensitized to methylchloroisothiazolinone and colophony&#44; histology showed a band-like lymphocytic infiltrate and in some areas without spongiosis&#44; clusters in the epidermis reminiscent of Pautrier microabscesses&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Detailed view of Pautrier pseudomicroabscesses&#46; The lesions resolved after avoidance of the causative allergens&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lupus erythematosus panniculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma in tattoos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma at the site of vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphocytoma cutis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphoma in acrodermatitis chronica atrophicans lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pseudolymphomatous folliculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphomatoid drug reaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morphea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acral pseudolymphomatous angiokeratoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T cell&#8211;rich angiomatoid polypoid pseudolymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pretibial lymphoplasmacytic plaque&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent arthropod bite reaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actinic reticuloid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen sclerosus et atrophicus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen aureus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Solitary T-cell pseudolymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichenoid keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphomatoid contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atypical lymphoid proliferation in patients with human immunodeficiency virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD30<span class="elsevierStyleSup">&#43;</span> pseudolymphomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunoglobulin G4-related disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Annular lichenoid dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palpable migratory arciform erythema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other cutaneous pseudolymphomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cutaneous Pseudolymphoma&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACE&#44; angiotensin-converting enzyme&#59; NSAIDs&#44; nonsteroidal anti-inflammatory drugs&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Ploysangam et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">36</span></a> Naciri Bennani et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">51</span></a> Imafuku et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0980"><span class="elsevierStyleSup">52</span></a> Fukamachi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0985"><span class="elsevierStyleSup">53</span></a> Guis et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0990"><span class="elsevierStyleSup">54</span></a> Stavrianeas et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0995"><span class="elsevierStyleSup">55</span></a> Welsh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1000"><span class="elsevierStyleSup">56</span></a> Kitagawa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1005"><span class="elsevierStyleSup">57</span></a> Macisaac et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1010"><span class="elsevierStyleSup">58</span></a> Kim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1015"><span class="elsevierStyleSup">59</span></a> Foley et al&#46;<a class="elsevierStyleCrossRef" href="#bib1020"><span class="elsevierStyleSup">60</span></a></p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anticonvulsants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phenytoin&#44; carbamazepine&#44; mephenytoin&#44; trimethadione&#44; phenobarbital&#44; primidone&#44; butabarbital&#44; methsuximide&#44; phensuximide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antipsychotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chlorpromazine&#44; thioridazine&#44; promethazine&#44; methylphenidate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antihypertensives</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACE inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril&#44; enalapril&#44; benazepril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#946;-Blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atenolol&#44; labetalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Calcium channel blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Verapamil&#44; diltiazem&#44; benidipine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Moduretic&#44; hydrochlorothiazide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cytotoxic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ciclosporin&#44; methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Rheumatology drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gold&#44; salicylates&#44; phenacetin&#44; D-penicillamine&#44; allopurinol&#44; NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antibiotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penicillin&#44; dapsone&#44; nitrofurantoin&#44; vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antidepressants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fluoxetine&#44; doxepin&#44; depramine&#44; amitriptyline&#44; lithium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anxiolytics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Benzodiazepines &#40;clonazepam&#44; lorazepam&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antihistamines</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diphenhydramine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">H2 antihistamines</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cimetidine&#44; ranitidine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antiarrhythmics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Procainamide&#44; mexiletine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Topical agents</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menthol&#44; eugenol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex hormones</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estrogens&#44; progesterone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lipid-lowering drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lovastatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Biologics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adalimumab&#44; infliximab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lornoxicam&#44; zoledronic acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Drugs Associated With Pseudolymphomatous Cutaneous Reactions&#46;</p>"
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      ]
      8 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Orbaneja et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1230"><span class="elsevierStyleSup">102</span></a> Marli&#232;re et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1245"><span class="elsevierStyleSup">105</span></a> Wall et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1250"><span class="elsevierStyleSup">106</span></a> Schena et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1255"><span class="elsevierStyleSup">107</span></a> Danese et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1260"><span class="elsevierStyleSup">108</span></a> Calzavara-Pinton et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1265"><span class="elsevierStyleSup">109</span></a> Fleming et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1270"><span class="elsevierStyleSup">110</span></a> Park et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1275"><span class="elsevierStyleSup">111</span></a> Komatsu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1280"><span class="elsevierStyleSup">112</span></a> Pely et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1285"><span class="elsevierStyleSup">113</span></a> Millican et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1290"><span class="elsevierStyleSup">114</span></a> Mendese et al&#46;<a class="elsevierStyleCrossRef" href="#bib1295"><span class="elsevierStyleSup">115</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Phosphorus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N<span class="elsevierStyleItalic">-</span>Isopropyl<span class="elsevierStyleItalic">-</span>N<span class="elsevierStyleItalic">-</span>phenyl<span class="elsevierStyleItalic">-</span>4<span class="elsevierStyleItalic">-</span>phenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ethylenediamine dihydrochloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Napthen cobalt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nickel sulfate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paraphenylenediamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gold sodium thiosulfate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Zinc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Squaric acid dibutylester&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Methylchloroisothiazolinone&#47;methylisothiazolinone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Allergens Implicated in Lymphomatoid Contact Dermatitis&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Pulitzer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1330"><span class="elsevierStyleSup">122</span></a> Gallardo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1335"><span class="elsevierStyleSup">123</span></a> Nathan and Belsito&#44;<a class="elsevierStyleCrossRef" href="#bib1340"><span class="elsevierStyleSup">124</span></a> Rose et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1345"><span class="elsevierStyleSup">125</span></a> Kim et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1350"><span class="elsevierStyleSup">126</span></a> Moreno-Ram&#237;rez et al&#46;<a class="elsevierStyleCrossRef" href="#bib1355"><span class="elsevierStyleSup">127</span></a></p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infectious&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Viruses</span><br><span class="elsevierStyleHsp" style=""></span>Orf<br><span class="elsevierStyleHsp" style=""></span>Molluscum contagiosum<br><span class="elsevierStyleHsp" style=""></span>Viral warts<br><span class="elsevierStyleHsp" style=""></span>Herpes simplex<br><span class="elsevierStyleHsp" style=""></span>Herpes zoster<br><span class="elsevierStyleItalic">Fungi</span><br><span class="elsevierStyleItalic">Mycobacteria</span><br><span class="elsevierStyleItalic">Leishmaniasis</span><br><span class="elsevierStyleItalic">Secondary syphilis</span><br><span class="elsevierStyleItalic">Infection due to</span> Stenotrophomonas maltophilia<br><span class="elsevierStyleItalic">Skin abscesses</span><br><span class="elsevierStyleItalic">Scabies</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Carbamazepine</span><br><span class="elsevierStyleItalic">Cefuroxime</span><br><span class="elsevierStyleItalic">Chemotherapy agents</span><br><span class="elsevierStyleHsp" style=""></span>Gemcitabine<br><span class="elsevierStyleItalic">Leuprolide</span><br><span class="elsevierStyleItalic">Doxepin</span><br><span class="elsevierStyleItalic">Antihypertensives</span><br><span class="elsevierStyleHsp" style=""></span>Atenolol<br><span class="elsevierStyleHsp" style=""></span>Amlodipine<br><span class="elsevierStyleHsp" style=""></span>Valsartan<br><span class="elsevierStyleHsp" style=""></span>Angiotensin-converting enzyme inhibitors<br><span class="elsevierStyleItalic">Isoflavones</span><br><span class="elsevierStyleItalic">Sertraline</span><br><span class="elsevierStyleItalic">Gabapentin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Arthropod bites</span><br><span class="elsevierStyleItalic">Hidradenitis</span><br><span class="elsevierStyleItalic">Gold acupuncture</span><br><span class="elsevierStyleItalic">Lymphocyte recovery rash</span><br><span class="elsevierStyleItalic">Pityriasis lichenoides et varioliformis</span><br><span class="elsevierStyleItalic">Red sea coral lesions</span><br><span class="elsevierStyleItalic">Atopic dermatitis</span><br><span class="elsevierStyleItalic">Sweet Syndrome</span><br><span class="elsevierStyleItalic">Stasis ulcers</span><br><span class="elsevierStyleItalic">Rhinophyma</span><br><span class="elsevierStyleItalic">Broken cysts</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Pseudolymphomatous Disorders With Possible CD30<span class="elsevierStyleSup">&#43;</span> Cell Proliferation&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:144 [
            0 => array:3 [
              "identificador" => "bib0725"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The lymphocytic infiltrates of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Pathol"
                        "fecha" => "1974"
                        "volumen" => "5"
                        "paginaInicial" => "25"
                        "paginaFinal" => "43"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0730"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histologic pseudomalignancies of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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