Dermatology - Mycosis Fungoides

Dermatology - Mycosis Fungoides
The most prevalent cutaneous lymphoma, mycosis fungoides, usually appears in mid-to-late adulthood and affects twice as many men as women.

The illness is frequently misdiagnosed as psoriasis, nummular dermatitis, and "large plaque" parapsoriasis and can last for months to years. It's possible that pruritus exists or that no symptoms exist. Lymphadenopathy can happen, frequently following the appearance of thick plaques and nodules.

Patients may experience multiple types of lesions at the same time. Patches can be well-formed or poorly defined, randomly dispersed, and scale or nonscaling in various red hues.
These begin as superficial conditions resembling dermatophytosis, psoriasis, or eczema, and then they thicken with time. Plaques often have an oval or circular shape, however they can also be arciform, annular, or bizarrely shaped. Although lesions are spread haphazardly, they frequently spare exposed parts in the early stages. Later lesions that include nodules and tumors, either with or without ulceration, are called tumors. Leonine facies may result from extensive infiltration. Erythroderma may result from convergence. Both hair loss and palmoplantar keratoderma are present. Poikiloderma may appear right away or develop gradually.


It is challenging to diagnose in the early stages. Even though repeated samples are performed, histologic confirmation of the typical clinical lesions may not be achievable for years. There seems to be a strong correlation between lymphadenopathy and aberrant T cell circulation in the blood and internal organ involvement. The differential comprises poikiloderma, eczema, and psoriasis.

Therapy is stage-adapted and focused on symptoms. Both PUVA photochemotherapy and narrowband UVB treatment are useful when the histologic diagnosis is only compatible but not confirmed, or when there is a histologically proven plaque-stage disease without lymphadenopathy or circulating T cells. They can also be used in conjunction with subcutaneous interferon-α, oral isotretinoin, or bexarotene. Topical carmustine, topical chemotherapy with nitrogen mustard in an ointment basis (10 mg/dL), and total body electron beam therapy, either alone or in combination, are also utilized at this point. Utilize local x-ray or electron beam treatment to treat localized malignancies. The best possible combination for patients with many tumors and an extensive plaque stage is chemotherapy with electron beam plus lymphadenopathy or aberrant circulating T lymphocytes.