Early‐Onset Hypopigmented Mycosis Fungoides in a Young Female: Navigating Diagnostic Delays and Treatment Complexities—A Case Report

Hypopigmented mycosis fungoides (HMF) is a variant of mycosis fungoides (MF). It is classified as a low-grade lymphoproliferative disorder and is often challenging to diagnose, especially in young, darker-skinned patients, due to its resemblance to benign conditions such as pityriasis alba, idiopathic macular hypomelanosis (IMH), parapsoriasis, postinflammatory hypopigmentation, vitiligo, and leprosy. We report a case of HMF in a 22-year-old Pakistani female presenting with progressive hypopigmented patches and plaques primarily on the back, groin, and trunk. The importance of early assessment in atypical HMF presentations is underscored by the delayed diagnosis despite multiple consultations. The diagnosis was confirmed through skin biopsy findings, which demonstrated CD4+ T-cell dominance. The first treatment, which included topical steroids and narrow-band UVB phototherapy, resulted in a partial remission. However, the patient relapsed within a few months and needed to be treated with methotrexate. This example highlights the importance of careful clinical, histological, and immunohistochemical testing for timely HMF detection as well as the need for vigilant monitoring to effectively manage recurrences.