Background: Hyperpigmented (lichenoid) form is a rare subtype of mycosis fungoides which presents with multiple pigmented macules and patches and characterized by a CD8+ phenotype on immunohistochemistry. Up to our knowledge, only limited cases of hyperpigmented MF have been reported so far. Objective: To study the clinical, histopathological, and immunohistochemical features of hyperpigmented lichenoid MF. Patients and methods: Patients with lichenoid MF who had attended department of dermatology, college of medicine, university of Baghdad, Baghdad teaching hospital during the period from 2006 through 2019, were collected. Results: Twelve patients, comprising around 11% of the patients seen with MF, had hyperpigmented lichenoid patches and plaques. Six patients presented with hyperpigmented patches as the only manifestation of MF. Five patients were presented with poikilodermatous patches in addition to areas of hyperpigmented lesions, and (poikilodermatous patches with ulceration in one patient). One patient had classic MF lesions in association with hyperpigmented MF. On histopathological study, atypical lymphocytes were noticed in the epidermis, with minimal spongiosis, and also at the dermoepidermal junction, causing focal damage. The striking feature was the large numbers of melanophages in the dermis. Conclusion: Hyperpigmented lesions of MF may be the sole manifestation or may coexist with other MF variants. The striking histopathological finding was mainly dermal melanosis. Other hyperpigmented dermatoses like lifa disease might be confused with pigmented MF. Early diagnosis and proper therapy might prevent the progression leading to full recovery.
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