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Progression from early\u2010stage disease (skin patches and\/or plaques) to more advanced stages (cutaneous tumours, erythroderma or extracutaneous involvement) occurs slowly and can be discontinuous. Prognosis is poor for the ~25% of patients who progress to advanced disease. Patients at any stage of MF may experience reduced health\u2010related quality of life (QoL) via a spectrum of physically and psychologically debilitating symptoms that can impact many aspects of daily life. Allogeneic stem\u2010cell transplantation is a curative treatment option for some patients with advanced disease, but otherwise there is currently no cure for MF; patients are often refractory to several treatments and require lifelong management. The goals of therapy are symptom control, prevention of disease progression, avoidance of treatment\u2010related toxicity and maintenance\/improvement of QoL. Although treatment regimens exist it can be difficult to know how to prioritize them, hence therapies are tailored according to patient needs and drug availabilities, following clinical recommendations. International consensus guidelines recommend skin\u2010directed therapies (SDTs) as first\u2010line treatment for early\u2010stage disease, and SDTs combined with systemic therapy for advanced stages. Chlormethine (CL), also known as mechlorethamine, chlorethazine, mustine, HN2, caryolysine and embichin, is a synthetic deoxyribonucleic acid\u2010alkylating agent that was used as a chemical weapon (mustard gas) during the First World War. Subsequent investigation revealed that survivors of mustard gas exposure had lymphocytopenia, and that CL could inhibit rapidly proliferating malignant T cells. CL has since been developed as a topical treatment for MF and prescribed as such for over 70\u2009years. This review aims to summarize the current knowledge regarding the mechanism of action of CL in the cutaneous micro\u2010environment, in the specific context of MF treatment.<\/jats:p>","DOI":"10.1111\/jdv.19237","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T18:29:39Z","timestamp":1685644179000},"page":"1739-1748","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Mechanism of action of chlormethine gel in mycosis fungoides"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5478-8735","authenticated-orcid":false,"given":"E.","family":"Guenova","sequence":"first","affiliation":[{"name":"University Hospital Lausanne (CHUV), Faculty of Biology and Medicine University of Lausanne  Lausanne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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