Lymphomatoid papulosis in children

Background: Although lymphomatoid papulosis is well described in adults, the clinical course, prognosis, risk for lymphoma, and recommendations for follow-up have not been established in children. Objective: Our aim was to analyze our data on six children with lymphomatoid papulosis and to analyze available information on reported cases from the literature to characterize better lymphomatoid papulosis in childhood and to compare it with adult-onset lymphomatoid papulosis. Methods: Clinical records, laboratory studies, and histopathologic evaluation of skin biopsy specimens from six children with lymphomatoid papulosis were reviewed. A literature search was also performed and disclosed detailed information on 17 childhood cases. Results: In most cases childhood lymphomatoid papulosis is clinically and histologically similar to lymphomatoid papulosis in adults, but three unusual patterns were identified in our children: first, after initial outbreak, dwindling outbreaks (both in frequency and number of lesions) until the eruption ceased completely; second, lymphomatoid papulosis localized to one area for years before generalizing, and third, presentation of lymphomatoid papulosis with hundreds of lesions. In our children and in those previously reported, response to systemic antibiotics and potent topical steroids was variable, as in adults. All our children to date have remained healthy; the longest period of follow-up is 9 years. However, in previously reported cases two patients with childhood-onset lymphomatoid papulosis had lymphoma as adults. Conclusion: Childhood lymphomatoid papulosis may be more likely to resolve spontaneously than adult lymphomatoid papulosis; nevertheless these children may still be at risk for lymphoma and thus need lifelong follow-up.