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A man in his 80s presented with a new-onset rash that had begun 4 months prior. On physical exam, he was found to have exfoliative erythroderma and palmoplantar keratoderma. In addition, numerous brown papules were scattered across the back, which the patient reported had erupted concurrently with his erythroderma ( figure 1). These papules were consistent with seborrheic keratoses (SK) both by clinical features and dermoscopy. Biopsy of the thigh showed a band-like atypical CD4+ lymphocytic infiltrate in the superficial dermis with epidermotropism. Peripheral blood flow cytometry showed an immunophenotypically discrete CD4+CD26− T cell population, and T cell receptor gamma gene rearrangement testing revealed matching clonal rearrangements in the blood and skin. The patient was diagnosed with Sezary syndrome Stage IVA1 and was started on extracorporeal photopheresis (ECP) two treatments every month, bexarotene 150 mg daily and peginterferon alfa-2 36 ug weekly. Following 7 months of treatment (12 ECP sessions), he achieved a near-complete resolution of skin erythroderma (<10% body surface area involvement) and complete resolution of blood involvement. At this time, his SKs had also spontaneously sloughed off without any additional intervention (figure 2).