Early clinical manifestations of Sézary syndrome: A multicenter retrospective cohort study

Aaron R. Mangold, Agnieszka K. Thompson, Mark D. Davis, Ieva Saulite, Antonio Cozzio, Emmanuella Guenova, Emmilia Hodak, Iris Amitay-Laish, Ramon M. Pujol, Mark R. Pittelkow, Robert Gniadecki

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background Classic Sézary syndrome (SS) is defined by erythroderma, generalized lymphadenopathy, and leukemic blood involvement. Clinical observations suggest that SS begins as a nonerythrodermic disease. Objective To describe the early clinical characteristics of patients with SS. Methods A retrospective, multicenter chart review was performed for 263 confirmed cases of SS diagnosed during 1976-2015. Results Erythroderma was the earliest recorded skin sign of SS in only 25.5% of cases, although most patients (86.3%) eventually developed erythroderma. In patients without erythroderma during their initial visit, the first cutaneous signs of SS were nonspecific dermatitis (49%), atopic dermatitis-like eruption (4.9%), or patches and plaques of mycosis fungoides (10.6%). The mean diagnostic delay was 4.2 years overall, 2.2 years for cases involving erythroderma at the initial presentation, and 5.0 years for cases not involving erythroderma at the initial presentation. Limitations This study is retrospective. Conclusion Erythroderma is uncommon as an initial sign of SS. Early SS should be considered in cases of nonerythrodermic dermatitis that is refractory to conventional treatments. In these cases, examination of the blood by PCR for monoclonal T-cell receptor rearrangement and by flow cytometry to identify an expanded or aberrant T-cell population should be considered.

Original languageEnglish (US)
Pages (from-to)719-727
Number of pages9
JournalJournal of the American Academy of Dermatology
Issue number4
StatePublished - Oct 2017


  • Sézary syndrome
  • cutaneous T-cell lymphoma
  • diagnosis
  • diagnostic delay
  • erythroderma
  • nonerythroderma
  • prognosis
  • survival

ASJC Scopus subject areas

  • Dermatology


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