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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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End of Skin-nontumor > Other dermatoses > Alopecia mucinosa
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