Granulomatous slack skin

A 32‐year‐old man presented with multiple subcutaneous swellings of 6 years' duration. A biopsy performed 6 years earlier, when the patient presented with papules and plaques, was reported as tuberculoid Hansen's disease. The patient received dapsone, but showed no improvement. The disease was progressive. The patient currently has bilateral parotid enlargement ( Fig. 1), enlarged submandibular, submental, and axillary lymph nodes, multiple subcutaneous swellings over the axillae and arms of cricket ball size, loose skin folds in the axillae ( Fig. 2) and groin, and dry, scaly, and ichthyotic skin all over the body. Clinical differential diagnoses of mycosis fungoides and cutis laxa were made. The patient was discharged on request and then was lost to follow‐up. 1Patient with bilateral parotid enlargement2Patient showing loose skin folds in axillae Biopsies taken from the axillary fold, right arm, and face revealed dense infiltration of the dermis and subcutis by aggregates of small lymphocytes, some exhibiting nuclear convolutions along with one or two Langhans‐type giant cells ( Fig. 3). A few giant cells showed evidence of lymphophagocytosis. Blood vessel walls were infiltrated by lymphocytes. Epidermotrophism was seen in biopsies from the arm and face (Fig. 4). There was partial loss of elastic fibers in the dermis. A histopathologic diagnosis of granulomatous slack skin (GSS) was made. 3Photomicrograph showing dense infiltration of the dermis and subcutis by lymphoid aggregates with one or two Langhans‐type giant cells. Epidermotropism was also noted (hematoxylin and eosin, × 10)