This 50 year old man had a history of Stage II Hodgkin's disease for which he received chemotherapy and radiation therapy over 30 years earlier. A year earlier he developed a diffuse red scaly rash with scattered indurated plaques studded with comedones and follicular pustules. The rash became more pustular and failed to improve with oral antibiotics. He was feeling well and denied fever, chills, night sweats, or swollen glands. Laboratory studies including a complete blood count, chemistry, liver function tests, thyroid function tests, chest X-ray, and body computer tomography scan were normal. Skin biopsies revealed T-cell lymphoma infiltrating the follicular epithelium and eccrine glands resulting in follicular obstruction and the clinically prominent comedones and follicular pustules..
A few CD8 positive cells are seen in the epidermis and dermis.