Skin-nontumor / Clinical dermatology
Other dermatoses
Alopecia mucinosa

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 23 June 2016, last major update July 2011

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Alopecia mucinosa

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
Micro 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
Micro Images

Images hosted on other servers:

Courtesy of Mowafak Hamodat, M.D.



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
Additional References