Table of Contents
Epidemiology | Clinical features | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosis | Additional referencesCite this page: Hamodat M. Alopecia mucinosa. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumoralopeciamucinosa.html. Accessed September 21st, 2023.
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:
- Infiltrated plaque, solitary or multiple, associated with alopecia when in scalp or beard area
- Group of of follicular papules, either localized or extensively distributed on trunk and proximal limbs in addition to scalp and face
- 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
- 61 year old woman with SLE (Dermatol Online J 2010;16:7)
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
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