Pautrier Microabscesses · What Are They, Diagnosis, and More

Published: Mar 30, 2026

Author: Anna Hernández, MD•

Editor: Alyssa Haag, MD•

Editor: Lily Guo, MD

Illustrator: Abbey Richard, MSc

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What are Pautrier microabscesses?

Pautrier microabscesses are one of the defining microscopic features of mycosis fungoides, the most common form of cutaneous T-cell lymphoma that results in erythematous patches (i.e. flat lesions > 1cm) or plaques (i.e. raised lesions >1cm) and tumors (i.e. solid, firm lesion), depending on the stage. These skin lesions commonly appear on sun-protected areas, such as the buttocks, trunk, and the axillary folds.

Pautrier microabscesses are not true abscesses (i.e. enclosed collection of pus) but rather a histopathology finding marked by intraepidermal nests of atypical, neoplastic, lymphocytes. For a long time, the discovery of Pautrier microabscesses was attributed to the French dermatologist Lucien-Marie Pautrier; although it is now thought it was Jean Ferdinand Darier, a French pathologist and dermatologist, who first described them.

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What causes Pautrier microabscesses?

Pautrier microabscesses are one of the hallmark findings of mycosis fungoides. Mycosis fungoides is a form of cutaneous T-cell lymphoma caused by the proliferation of malignant T-cells, primarily CD4+ T-helper cells. These cells express adhesion molecules that bind to receptors on the surface of endothelial cells found on the skin’s blood vessels, which facilitates their migration from the blood to the skin. Once in the skin, malignant T-cells move towards the epidermis where they cluster together, forming dermal infiltrates known as Pautrier microabscesses.

What are the signs and symptoms of mycosis fungoides?

Skin lesions in mycosis fungoides go through several different stages. At first, they look like reddish patches with overlying scaly, wrinkled skin. As the disease progresses, patches evolve into thickened plaques with a rough appearance. Initially, plaques are confined to certain skin areas, but over time, they may affect the whole body. The final stage of mycosis fungoides is the development of tumors, which can appear over healthy skin or on top of patches and plaques. In certain cases, malignant T-cells may leave the skin and start to circulate in the blood, resulting in a leukemic form of cutaneous T-cell lymphoma known as Sezary syndrome. Sezary syndrome is a rare and aggressive condition that presents with erythroderma, a red, itchy rash that affects almost the whole-body surface. In addition to the bloodstream, malignant T-cells can travel to nearby lymph nodes and, more rarely, to the liver, spleen, or gastrointestinal tract. This can result in swelling of the lymph nodes and hepatosplenomegaly, or enlargement of the liver and spleen. Mycosis fungoides is mostly seen in older adults, aged 50-55 years, although anyone may be affected.

How are Pautrier microabscesses diagnosed?

Pautrier microabscesses are diagnosed based on a skin biopsy. Under the microscope, they appear as small vesicles of atypical lymphocytes within the epidermis. Mycosis fungoides is also characterized by malignant lymphocytes that are small to medium in size and have distinctive cerebriform nuclei, named so because the nuclear membrane has many folds, resembling a brain. As mycosis fungoides progresses, epidermotropism, or the migration of lymphocytes into the epidermis, becomes more apparent. Other histological features of mycosis fungoides include lymphocytes with perinuclear clearing, giving a halo appearance and a bandlike infiltrate of lymphocytes in the papillary dermis (i.e. top layer of the dermis).

How is mycosis fungoides treated?

Treatment of mycosis fungoides varies depending on the stage of the disease and the risk of progression. Early stages are usually treated with topical corticosteroids, immunomodulators (e.g. imiquimod), and phototherapy (e.g. ultraviolet-B [UVB] and PUVA). PUVA combines psoralen, a photosensitizing agent, with ultraviolet-A (UVA) rays to treat skin lesions by inducing death of skin cells. For advanced cases, systemic treatments like vitamin A derivatives (e.g. acitretin, bexarotene), total skin electron-beam radiotherapy (TSEBT), immunotherapy with interferon-alpha, chemotherapy (e.g. fludarabine, bleomycin, vincristine), and monoclonal antibodies such as brentuximab vedotin may be used.

What are the most important facts to know about Pautrier microabscesses?

Pautrier microabscesses are one of the defining microscopic features of mycosis fungoides, a type of cutaneous T-cell lymphoma that causes patches, plaques, and tumors in photo-protected areas of the skin. Under the microscope, Pautrier microabscesses can be seen as little clusters of atypical lymphocytes in the epidermis. Diagnosis of mycosis fungoides can be confirmed with a skin biopsy, showing dermal infiltrates of malignant CD4+ T-cells. Treatment depends on the stages of the disease and may include topical treatment or systemic therapy. Systemic therapies are the mainstay for advanced disease and include various options, such as immunomodulators, chemotherapy, and monoclonal antibodies.

References

Kelati A, Gallouj S, Tahiri L, Harmouche T, Mernissi FZ. Defining the mimics and clinico-histological diagnosis criteria for mycosis fungoides to minimize misdiagnosis. International Journal of Women’s Dermatology. 2017;3(2): 100–106. doi:10.1016/j.ijwd.2016.11.006

Madhumita M, Bhat R. Pautrier’s microabscess: An eponym by mistake. Indian Journal of Dermatology, Venereology and Leprology. 2020;86(6): 747. doi:10.4103/ijdvl.ijdvl_1100_19

Song SX, Willemze R, Swerdlow SH, Kinney MC, Said JW. Mycosis fungoides. American Journal of Clinical Pathology. 2013;139(4): 466–490. doi:10.1309/ajcpobdp2oqaj5br