Mycosis fungoides is a significant diagnostic challenge due to overlapping clinicopathologic features with common cutaneous inflammatory diseases. A thirty five year old female, known case of acquired ichthyosis vulgaris was diagnosed clinically and histologically to have Mycosis fungoides - Granulomatous type after a disease course of 8 months due to delayed diagnosis. This patient was operated for a right cheek mass 8 months back in view of hemangioma by a plastic surgeon. Biopsy report suggested pseudo tumor/lymphoma and advised immunochemistry for further confirmation. Patient lost follow-up due to multiple reasons. The disease flared up in next 6 months with multiple skin to dark coloured painless swelling with no oozing over bilateral gluteal region and legs followed by mild discomfort. All the swellings developed only on ichthyotic patches. Skin biopsy showed features of basal lymphocyte tagging, pautrier microabcesses and epidermotropism with all special stains for fungal, acid fast bacilli and lepra bacilli negative. Immunohistochemistry revealed CD3 (95% positivity), CD4 (90% positivity) and CD7 (<10% positivity). PET CT findings were consistent with mycosis fungoides with no metastasis. Patient is currently undergoing chemotherapy treatment and responded well to chemotherapy.This case is peculiar that patient did not have itching in spite of presence of ichthyosis and extensive disease involvement. It also provides an insight to consider the risk of mycosis fungoides in patients with acquired ichthyosis vulgaris due to super-antigen stimulation because of increased penetration of solvents and infectious agents.

Key words: Mycosis fungoides,ichthyosis vulgaris, immunohistochemistry, CTCL, histopathology

Mithra S, an accomplished dermatologist, serves as the Founder & Chief Dermatologist at Cutis Parasol Skin/Hair/Nail/Laser Clinic in Chennai. Additionally, she holds positions as a Consultant Dermatologist at both Chettinad Superspeciality Hospital and Kauvery Hospital, Radial Road. She was completed her MD (DVL) at Govt. Stanley Hospitals and Medical College, Chennai, her career has been marked by a profound interest in clinical dermatology and aesthetic medicine.

Her journey in research commenced during under-graduation, and she actively contributes to ongoing research and publications, showcasing her commitment to advancing dermatological knowledge. She stands out for her enthusiasm in embracing innovative technologies, seamlessly integrating evidence-based medical practices to enhance patient care. Her multifaceted roles across prestigious institutions in Chennai reflect a dedication to delivering high-quality and progressive dermatological treatments to her patients.