Skin inflammatory (nontumor)
Alopecia
Alopecia mucinosa

Author: Mowafak Hamodat, M.D., M.Sc. (see Authors page)

Revised: 17 October 2018, last major update July 2011

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PubMed Search: Alopecia mucinosa

Cite this page: Hamodat, M. Alopecia mucinosa. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skinnontumoralopeciamucinosa.html. Accessed December 16th, 2018.
Epidemiology
  • Coexisting lymphoma associated with very poor prognosis
Clinical features
  • 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
Case reports
Microscopic (histologic) description
  • 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
Microscopic (histologic) images

Images hosted on other servers:

Contributed by Mowafak Hamodat, M.D., M.Sc.

Various images



Mucin between follicular keratinocytes

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

Positive stains
  • Alcian blue
Differential diagnosis
  • 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