What should you know about hyperpigmented mycosis fungoides?

Mycosis fungoides begins in the skin and may resemble a patchy, scaly, itchy, or colour-changing rash. In a hyperpigmented pattern, darker areas may be more noticeable than redness. The patches can occur on areas covered by clothing and may persist or change gradually. Appearance alone cannot confirm the diagnosis because eczema, post-inflammatory pigment, fungal rashes, and other conditions can overlap.

Diagnosis usually brings together the history, skin examination, and tissue sampling when indicated. Several assessments may be needed because early changes can be subtle. This is a condition for specialist follow-up, even when the skin findings are limited.

Keep a record of new patches, scale, itch, symptoms, and treatment response, and attend scheduled dermatology or oncology reviews. Use gentle cleansers and moisturiser, avoid scratching, and tell the care team about new lumps, persistent infections, or unusual fatigue.

Treatment depends on the extent and behaviour of the skin disease. Options may include narrowband UVB phototherapy, PUVA therapy, or topical corticosteroids. Your specialist will select the approach, explain monitoring, and adjust it if the skin response or diagnosis changes.

Contact your specialist for rapidly expanding patches, thickened plaques, new nodules, open or bleeding areas, severe itch, fever, or signs of infection. Seek urgent medical help for widespread skin peeling, facial swelling, breathing difficulty, or a severe reaction after treatment.

Ask what findings support the diagnosis, whether another biopsy or blood test is needed, how the skin will be monitored, and what changes should be reported. Discuss the purpose, schedule, eye or skin precautions, and possible reactions for each proposed treatment.