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Fungal mycosis: causes, symptoms, diagnosis, treatment

 
, medical expert
Last reviewed: 07.07.2025
 
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Mycosis fungoides is a rare chronic T-cell lymphoma that initially affects the skin and sometimes internal organs.

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Symptoms mycosis fungoides

Mycosis fungoides is less common than Hodgkin's lymphoma and other types of non-Hodgkin's lymphoma. Mycosis fungoides has an insidious onset, often manifesting as a chronic itchy rash that is difficult to diagnose. Starting locally, it can spread, affecting most of the skin. The lesions are similar to plaques, but can manifest as nodules or ulcers. Subsequently, systemic damage to the lymph nodes, liver, spleen, lungs develops, and systemic clinical manifestations are added, which include fever, night sweats, unexplained weight loss.

Diagnostics mycosis fungoides

The diagnosis is based on skin biopsy, but the histology may be questionable in the early stages due to the lack of lymphoma cells. The malignant cells are mature T cells (T4, T11, T12). Microabscesses are characteristic and may appear in the epidermis. In some cases, a leukemic phase called Sezary syndrome is detected, characterized by the appearance of malignant T cells with convoluted nuclei in the peripheral blood.

Staging of mycosis fungoides is done using CT scanning and bone marrow biopsy to assess the extent of the lesion. If visceral organ involvement is suspected, PET may be performed.

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Treatment mycosis fungoides

Highly effective are accelerated electron beam radiation therapy, in which the energy is absorbed in the outer 5-10 mm of tissue, and local treatment with nitrogen mustard. Phototherapy and local glucocorticoids can be used to target plaques. Systemic therapy with alkylating agents and folate antagonists results in temporary tumor regression, but these methods are used when other therapies have failed, after relapse, or in patients with documented extranodal and/or extracutaneous involvement. Extracorporeal phototherapy in combination with chemosensitizers has demonstrated moderate efficacy. Promising in terms of efficacy are the adenosine deaminase inhibitors fludarabine and 2-chlorodeoxyadenosine.

Forecast

Most patients are diagnosed after the age of 50. Average life expectancy after diagnosis is about 7-10 years, even without treatment. Survival of patients depends on the stage at which the disease is detected. Patients who received therapy at stage IA of the disease have a life expectancy similar to people of the same age, gender, and race who do not have mycosis fungoides. Patients who received treatment at stage IIB of the disease have a survival rate of about 3 years. Patients treated at stage III of the disease have an average survival rate of 4-6 years, and at stage IVA or IVB (extranodal lesions) the survival rate does not exceed 1.5 years.

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