Prevalence and treatment of palmoplantar keratoderma and tinea pedis in patients with Sézary syndrome

Int J Dermatol. 2012 Oct;51(10):1195-8. doi: 10.1111/j.1365-4632.2011.05204.x.


Background: Mycosis fungoides (MF) and the Sézary syndrome (SS) are non-Hodgkin's lymphomas that present with cutaneous lesions. Sézary syndrome is characterized by blood involvement, exfoliative eryrthroderma, lymphadenopathy, pruritus, keratoderma, and immunosuppression. This study was to estimate the prevalence of palmoplantar keratoderma and tinea pedis in Sézary syndrome and to analyze the effectiveness of anti-fungal treatment.

Methods: We conducted a retrospective review of 1562 prospectively collected patients at the MD Anderson Cancer Center Cutaneous Lymphoma Clinic over sixteen years. All patients' palms and soles were evaluated for clinical evidence of keratoderma (hyperkeratosis) and for dermatophytosis (tinea pedis or unguum) by examining scales under 10% potassium hydroxide by light microscopy for hyphae.

Results: Of 138 Sézary syndrome patients (88 men, 50 women, median age at diagnosis 64 years), 85 (61.6%) had palmoplantar keratoderma; 45 of the 85 Sézary syndrome patients (52.9%) also had coexisting tinea pedis. Only 14 (10.1%) had tinea pedis without keratoderma. Treatment for tinea pedis resulted in microscopy cure of keratoderma in 12 of 45 (26.7%) patients and clinical improvement.

Conclusions: The prevalence of palmoplantar keratoderma in Sézary syndrome is 61.6%, with co-existing tinea pedis found in 52.9%. Palmoplantar keratoderma with tinea pedis showed clinical improvement with fungicidal therapy suggesting that tinea often contributes to the pathogenesis and severity of Sézary syndrome-related keratoderma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / therapeutic use
  • Female
  • Humans
  • Hyphae / isolation & purification
  • Incidence
  • Keratoderma, Palmoplantar / drug therapy
  • Keratoderma, Palmoplantar / epidemiology*
  • Keratoderma, Palmoplantar / etiology
  • Keratoderma, Palmoplantar / microbiology
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Severity of Illness Index
  • Sezary Syndrome / drug therapy
  • Sezary Syndrome / epidemiology*
  • Sezary Syndrome / microbiology
  • Skin Neoplasms / drug therapy
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / microbiology
  • Tinea Pedis / complications
  • Tinea Pedis / drug therapy
  • Tinea Pedis / epidemiology*
  • Tinea Pedis / microbiology
  • Young Adult


  • Antifungal Agents