By Gary M. White, MD
Courtesy of James Steger, MD.
Granulomatous slack skin is a rare variant of cutaneous T-cell lymphoma (CTCL) in which there is thickening and folding of the skin often of the axilla but also the groin. Patients are at high risk (up to 50% in reported cases) for secondary lymphoproliferative neoplasms, most commonly Hodgkin's disease and non-Hodgkin's lymphoma, but also acute myeloid leukemia and Langerhans cell histiocytosis.
Red, infiltrated plaques which may have epidermal atrophy and fine scale may develop initially. Later, these areas become wrinkled and pendulous. Large hanging, bag-like folds may be seen. The axilla, groin, and abdomen are most commonly affected. The majority of patients are men.
No treatment is consistently effective. Treatments have included topical steroids, PUVA, radiotherapy, imuran, chlorambucil, surgical debulking, and topical nitrogen mustard. In one patient, acute exacerbation was successfully treated with system recombinant interferon-gamma. Surgical excision is usually accompanied by recurrence within months.
Granulomatous slack skin. Dermatology Online Journal 12 (7): 20
JAAD February 2014 Volume 70, Issue 2, Pages 205.e1–205.e16