Hungarian Journal of Dermatology and Venereology

Recognition of early mycosis fungoides

József Szakonyi — 2025-10-31

Although mycosis fungoides is the most common type of cutaneous lymphomas, recognizing its early stage remains a challenging task due to its typically mild, non-specific, slowly evolving clinical symptoms that often resemble more common skin disorders. As a result, establishing the correct diagnosis usually takes a prolonged period, and several years may pass from the onset of symptoms to an accurate diagnosis. In this summary, we describe the clinical manifestations of early-stage mycosis fungoides, highlighting the features that may indicate the development of cutaneous T-cell lymphoma. We outline the diagnostic process step by step and aim to provide practical guidance to improve diagnostic efficiency in clinical practice. Furthermore, we review the conditions that pose a differential diagnostic challenge and identify potential risk factors for disease development.

Erythroderma Part I. Erythrodermic form of cutaneous T-cell lymphoma (CTCL)

Márta Marschalkó — 2025-10-31

Erythrodermic cutaneous T-cell lymphoma (E-CTCL) includes erythrodermic (E) mycosis fungoides (E-MF) and Sézary syndrome (SS), considered to be two distinct clinical entities, although related. Clinical characteristics of E-MF and SS are similar, with a hallmark of erythroderma and varying numbers of Sézary cells in the blood. Distinguishing between E-MF and SS relies on determining the degree of blood involvement, based on the expanded criteria for B classification from the ISCL-EORTC. Epidermotropic infiltrate of atypical, monoclonal, CD4+ lymphoid cells can be present in both dise ases with minor differences in the quantity of the infiltrating cells, in dermal changes, and in the presence of nonspecific histology. Clinicopathologic findings can be subtle and may mimic benign dermatoses. Thus, immunohistochemistry, molecular analysis, and blood flow cytome try are essential for accurate diagnosis.

Erythroderma Part II. Erythroderma of other origin (Non-CTCL erythroderma), clinical presentation, differential diagnosis, therapy

Adrienn Erzsébet Bojtor — 2025-10-31

Erythroderma is a rare, potentially life-threatening dermatological condition that can be caused by various inflammatory, autoimmune, infectious, drug-induced, and neoplastic diseases. Recognition and differential diagnosis of this condition is particularly complex, as different etiologies may present with similar clinical features. This article reviews the clinical characteristics of erythroderma unrelated to cutaneous T-cell lymphoma (CTCL); however, particular attention is given to CTCL cases associated with dupilumab treatment. The classification of the disorder is presented according to age and underlying pathomechanism, and the corresponding therapeutic approaches are outlined. In addition, a practical diagnostic algorithm is presented, which aims to increase the efficiency of etiological differentiation and support the selection of appropriate treatment.

The relationship between papuloerythroderma of Ofuji and cutaneous lymphomas

Tünde Zsuzsanna Kerner — 2025-10-31

Papuloerythroderma of Ofuji (PEO) is a rare dermatological condition characterized by pruritic, brownish-erythematous, flat, confluent papules with sparing of the skin folds – the so-called “deck-chair sign.” Although its etiology is not fully understood, numerous cases have been reported in association with various infections, drug-induced reactions, atopic dermatitis, internal organ malignancies, and hematologic cancers – including cutaneous T-cell lymphomas. This summary aims to present the disease and to review and analyze its association with cutaneous lymphomas based on the available literature.

Lymphomatoid papulosis

Máté Bognár — 2025-10-31

Lymphomatoid papulosis (LyP) is a rare, chronic, relapsing disease characterized by papulonodular or papuloulcerative skin lesions. According to the 2018 WHO-EORTC classification, it belongs to the spectrum of primary cutaneous CD30-positive T-cell lymphoproliferative disorders, with several histological subtypes (A, B, C, D, E, and a variant associated with DUSP22-IRF4 gene rearrangement). Although histologically similar to malignant lymphomas, its clinical course is considered an indolent hematological condition. The papules and nodules tend to regress spontaneously, but ulceration may occur in certain types. In mild cases, local therapy is sufficient, while severe or extensive cases may require systemic immunomodulatory or targeted therapy. Despite its rarity and generally favorable prognosis, the increased risk of secondary hematological malignancies (5–25%) highlights the importance of close follow-up. This article reviews the latest classification, pathomechanism, diagnostic algorithm, and treatment options for LyP based on international and Hungarian literature.

Skin-directed therapies in early stage mycosis fungoides

Boglárka Nagy — 2025-10-31

Skin-directed therapies (SDTs) represent the first-line treatment in the early stages (IA–IIA) of mycosis fungoides (MF), while in advanced disease they complement systemic therapies to alleviate symptoms and improve quality of life. In this article, the authors review the skin-directed therapeutic options for early-stage MF in the context of current international guidelines, with particular emphasis on topical nitrogen mustard. The first Hungarian report on its successful use in MF was published nearly seventy years ago in the Hungarian Journal of Dermatology and Venereology, by Sipos, in 19…... At present, chlormethine gel is the only topical preparation approved and available in Hungary for the treatment of MF.

Allogeneic hematopoietic stem cell transplantation in cutaneous T-cell lymphoma – A rarely applied but potentially curative therapeutic option

Alexandra Raska — 2025-10-31

The management of advanced-stage cutaneous T-cell lymphomas (CTCL) remains a major clinical challenge due to the pronounced biological and clinical heterogeneity of the disease and its frequent resistance to therapy. Durable remission can be achieved solely through allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this summary, we review the role of allo-HSCT in CTCL, based on a retrospective analysis of patients who underwent stem cell transplantation in Budapest between 1984 and 2024, in comparison with international data. CTCL accounted for only 0.5% of adult allo-HSCTs performed over the past 40 years. The majority of patients underwent transplantation in advanced stage disease, following a median of three prior lines of therapy, either in partial remission or with progressive disease. Conditioning regimens were reduced-intensity (RIC) in 67% and myeloablative (MAC) in 33% of cases. Acute graft-versus-host disease (GVHD) involving the skin occurred in 67% of patients. Overall mortality was 67%, and the relapse rate was 44%. Durable remission was achieved in some cases of late relapse with donor lymphocyte infusion (DLI). Although allo-HSCT offers curative potential in CTCL, its application remains limited. Closer cooperation among disciplines involved in the management of these patients may promote its more widespread use.