Acral angiokeratoma‐like pseudolymphoma in a middle‐aged woman

Acral angiokeratoma‐like pseudolymphoma is a rare type of pseudolymphoma presenting as dark‐red papules on the hand or foot. We describe a 59‐year‐old woman who presented with an unusual unilateral, clustered aggregate of scaly violaceous papules on the toe with an indolent course. Skin biopsy showed a prominent vascular proliferation associated with a dermal infiltrate of monoclonally rearranged T‐follicular helper phenotype T‐cells, in keeping with CD4+ small/medium T‐cell lymphoproliferative disorder (SMPTC‐LPD). Based on the unique clinical morphology, distribution of the lesions and dermoscopic appearance, a clinicopathologic diagnosis of acral angiokeratoma‐like pseudolymphoma was favored. This case demonstrates the importance of clinicopathological correlation in such diagnostically challenging patients who present with overlapping features on the spectrum of pseudolymphoma and cutaneous T‐cell lymphoma.