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Skin-nontumor

Other dermatoses

Alopecia mucinosa


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 7 November 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Clinical features
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● Also called follicular mucinosis
● Edematous and erythematous plaques of alopecia on head and neck
Children: benign, self-limited
Adults: associated with cutaneous T cell lymphoma, Sezary syndrome, Hodgkin lymphoma, acute myeloblastic leukemia, chronic lymphocytic lymphoma and squamous cell carcinoma of the tongue
● Nodular or plaquelike lesion
● Patterns: (1) infiltrated plaque, solitary or multiple, associated with alopecia when in scalp or beard area; (2) group of of follicular papules, either localized or extensively distributed on trunk and proximal limbs in addition to scalp and face; (3) acneiform lesion with comedones, mucinorrhea (discharge of mucinous fluid from follicular ostia) and severe pruritis
● Clinical course: either spontaneous regression, chronic relapsing but benign course over many years or associated with lymphoma

Epidemiology
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● Coexisting lymphoma associated with very poor prognosis

Clinical images
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Various images

Case reports
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● 61 year old woman with SLE (Dermatol Online J 2010;16:7)

Micro description
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● Follicular infundibulum keratinocytes and outer root sheath are separated by pools of mucin
● Mixed infiltrate of lymphocytes, histiocytes and conspicuous eosinophils
● Marked follicular dilation with cyst formation and perifollicular scarring
● Both the dermis and and affected epithelium are typically infiltrated by lymphocytes, histiocytes and eosinophils
● In cases associated with lymphoma, atypical lymphocytes, convoluted lymphocytes, large transformed cells and mitotic figures may be seen

Micro images
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Mucin between follicular keratinocytes (right: Alcian blue)


Superficial and deep, perivascular and perifollicular, infiltrate of lymphocytes and numerous eosinophils

           
Contributed by Dr. Mowafak Hamodat

Positive stains
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● Alcian blue

Differential diagnosis
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Coexisting mycosis fungicides: has atypical or cerebriform lymphocytes, bandlike infiltrate in upper dermis, no/minimal eosinophils; obtain multiple biopsies as needed; note: TCR gene rearrangement present in 50% of patients whether associated with tumor or not

Additional references
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eMedicine

End of Skin-nontumor > Other dermatoses > Alopecia mucinosa


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