Differential Diagnosis of Mycosis Fungoides: A Review of Literature
Turkish Journal of Dermatology, cilt.19, sa.1, ss.19-26, 2025 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 19 Sayı: 1
- Basım Tarihi: 2025
- Doi Numarası: 10.4274/tjd.galenos.2024.49469
- Dergi Adı: Turkish Journal of Dermatology
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Central & Eastern European Academic Source (CEEAS), CINAHL, EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.19-26
- Anahtar Kelimeler: Mycosis fungoides, poikiloderma, folliculitis, hypopigmentation, hyperpigmentation, blister, palmoplantar keratoderma, Woringer-Kolopp, disease, granulomatous disease, granulomatous slack skin
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, often experiences delayed diagnosis because of its ability to mimic numerous other conditions. Early-stage MF patches and plaques are frequently misdiagnosed as eczema, fungal infections, or psoriasis, leading to unnecessary treatments. However, the real challenge in differential diagnosis arises with MF’s clinical variants and atypical localizations. The poikilodermatous variant may be confused with dermatomyositis and lupus erythematosus due to acquired poikiloderma; however, unlike these conditions, MF lesions typically occur in non-sun-exposed areas. MF presenting as pustules clinically resembles pustular psoriasis, subcorneal pustular dermatosis, and folliculitis. Atypical lymphocytes can induce follicular hyperkeratosis, which may lead to MF being mistaken for lichen spinulosus or keratosis pilaris. The bullous variant of MF can present with subcorneal, intraepidermal, or subepidermal vesicle bulla formation, resulting in lesions that resemble erythema multiforme, dyshidrotic eczema, or autoimmune bullous diseases. Both hyperpigmentation and hypopigmentation can be caused by MF. Hypopigmentation can mimic vitiligo, progressive macular hypomelanosis, and leprosy, whereas hyperpigmentation may resemble postinflammatory hyperpigmentation, lichen planus pigmentosus, pigmented actinic keratosis, and ashy dermatosis. Similar to systemic lymphomas, MF can also induce acquired ichthyosis, necessitating differentiation from both systemic and dermatological conditions that cause this skin disorder. In certain systemic lymphomas, such as MF, annular erythematous patches or plaques may develop. Histopathological examination is essential for distinguishing annular lesions that may clinically resemble erythema annular centrifugum, subacute lupus erythematosus, or juvenile annular lichenoid dermatitis. However, the clinical and histopathological findings of MF can vary significantly. When granulomatous infiltration is observed in the dermis, MF can be misdiagnosed as granuloma annular, sarcoidosis, leprosy, or acquired cutis laxa. Solitary erythematous papules, plaques, nodules, or alopecia may occur infrequently, and the differential diagnosis depends on the lesion’s location. The urticarial variant, which is characterized by urticarial lesions, can be mistaken for urticarial drug reactions, T-cell leukemia, and lymphomas. When localized to the palmoplantar region, the condition can be confused with eczema, palmoplantar psoriasis, or palmoplantar keratoderma.