Alopecia Mucinosa Clinical Presentation

  • Author: Gervaise L Gerstner, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 13, 2012
 

History

The presenting sign of alopecia mucinosa is hair loss in hair-bearing areas. Skin eruptions present as pruritic, pink–to–yellow-white, follicular papules and plaques. Lesions may be isolated or multiple. Mycosis fungoides is recognized at the time of diagnosis in approximately 15-30% of patients with alopecia mucinosa.

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Physical

The clinical manifestations of alopecia mucinosa are grouped follicular papules and alopecia. Nodules, plaques, and patches of follicular papules may exist. Occasionally, mucinous material can be expressed from active lesions, and erythema and scaling are usually present. The face and the scalp are the most common sites of involvement.

The alopecia that develops on hair-bearing skin is of the nonscarring type (see the image below).

Courtesy of San Antonio Uniformed Services Health Courtesy of San Antonio Uniformed Services Health Education Consortium (SAUSHEC) teaching files.

Usually, the alopecia is reversible unless follicular destruction has occurred due to excess mucin in the outer root sheath and sebaceous glands. In patients with permanent alopecia, the whole follicle degenerates, and the cystic cavity becomes blocked with keratinous debris. When the plugs persist, they are obvious features on healed, hairless patches of alopecia mucinosa.

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Causes

Alopecia mucinosa represents various stages of follicular damage leading to hair loss. The reactive process is of unknown etiology. The role of circulating immune complexes and cell-mediated immunity has been considered.

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Contributor Information and Disclosures
Author

Gervaise L Gerstner, MD  Assistant Clinical Professor, Department of Dermatology, Mount Sinai Hospital; Partner, Park Avenue Skin Care

Disclosure: Nothing to disclose.

Coauthor(s)

Mark G Lebwohl, MD  Chairman, Department of Dermatology, Mount Sinai School of Medicine

Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Amgen/Pfizer Honoraria Consulting; Centocor/Janssen Honoraria Consulting; DermiPsor Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; HelixBioMedix Honoraria Consulting; Novartis Honoraria Consulting; Ranbaxy Lectures; Can-Fite Biopharma Honoraria Consulting; DermaGenoma Honoraria Consulting; Biosynexus Honoraria Consulting

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Pinkus H. Centennial Paper. Alopecia mucinosa. Inflammatory plaques with alopecia characterized by root-sheath mucinosis. By Hermann Pinkus, M.D., Arch Dermatol 1957. Arch Dermatol. Aug 1983;119(8):690-7. [Medline].

  2. Dalle S, Marrou K, Balme B, Thomas L. Neonatal follicular mucinosis. Br J Dermatol. Sep 2007;157(3):609-10. [Medline].

  3. Buchner SA, Meier M, Rufli T. Follicular mucinosis associated with mycosis fungoides. Dermatologica. 1991;183(1):66-7. [Medline].

  4. Clark-Loeser L, Latkowski JA. Follicular mucinosis associated with mycosis fungoides. Dermatol Online J. Nov 30 2004;10(3):22. [Medline].

  5. Lacour JP, Castanet J, Perrin C, Ortonne JP. Follicular mycosis fungoides. A clinical and histologic variant of cutaneous T-cell lymphoma: report of two cases. J Am Acad Dermatol. Aug 1993;29(2 Pt 2):330-4. [Medline].

  6. Bi MY, Curry JL, Christiano AM, Hordinsky MK, Norris DA, Price VH, et al. The spectrum of hair loss in patients with mycosis fungoides and Sézary syndrome. J Am Acad Dermatol. Jan 2011;64(1):53-63. [Medline].

  7. Dalle S, Balme B, Berger F, Hayette S, Thomas L. Mycosis fungoides-associated follicular mucinosis under adalimumab. Br J Dermatol. Jul 2005;153(1):207-8. [Medline].

  8. Scheinfeld N. Imatinib mesylate and dermatology part 2: a review of the cutaneous side effects of imatinib mesylate. J Drugs Dermatol. Mar 2006;5(3):228-31. [Medline].

  9. Roth DE, Owen LG, Hodge SJ, Callen JP. Follicular mucinosis associated with pregnancy. Int J Dermatol. Jun 1992;31(6):441-2. [Medline].

  10. Lockshin BN, Khachemoune A, Cohen C. Follicular mucinosis in a 4-year-old boy. Int J Dermatol. Dec 2004;43(12):950-2. [Medline].

  11. Nickoloff BJ, Wood C. Benign idiopathic versus mycosis fungoides-associated follicular mucinosis. Pediatr Dermatol. Mar 1985;2(3):201-6. [Medline].

  12. Gibson LE, Muller SA, Leiferman KM, Peters MS. Follicular mucinosis: clinical and histopathologic study. J Am Acad Dermatol. Mar 1989;20(3):441-6. [Medline].

  13. Fernandez-Guarino M, Harto Castano A, Carrillo R, Jaen P. Primary follicular mucinosis: excellent response to treatment with photodynamic therapy. J Eur Acad Dermatol Venereol. Mar 2008;22(3):393-4. [Medline].

  14. Meissner K, Weyer U, Kowalzick L, Altenhoff J. Successful treatment of primary progressive follicular mucinosis with interferons. J Am Acad Dermatol. May 1991;24(5 Pt 2):848-50. [Medline].

  15. Coskey RJ, Mehregan AH. Alopecia mucinosa. A follow-up study. Arch Dermatol. Aug 1970;102(2):193-4. [Medline].

  16. Emmerson RW. Follicular mucinosis. A study of 47 patients. Br J Dermatol. Jun 1969;81(6):395-413. [Medline].

 
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Courtesy of Dirk M. Elston, MD.
Courtesy of Dirk M. Elston, MD.
Courtesy of San Antonio Uniformed Services Health Education Consortium (SAUSHEC) teaching files.
 
 
 
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