Alopecia Mucinosa Workup

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

Laboratory Studies

A history and physical examination are the first steps.

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Procedures

Multiple skin biopsy samples are needed in the evaluation of patients with alopecia mucinosa because of the association with lymphoma.

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Histologic Findings

The characteristic features of alopecia mucinosa are follicular degeneration with the accumulation of mucin within the follicles (see the image below). Early lesions contain an abundance of mucin between the decaying root sheath cells or pooling in localized collections. The mucinous degeneration begins in the pilosebaceous units. A periappendiceal, perivascular, or interstitial lymphocytic mixed inflammatory cell infiltrate often exists. In patients with chronic alopecia mucinosa, the histologic analysis demonstrates the presence of distorted follicles with variable viability.

Courtesy of Dirk M. Elston, MD. Courtesy of Dirk M. Elston, MD.

Differentiation between the variants of alopecia mucinosa is difficult; thus, several criteria are used to differentiate the histologic features of benign alopecia mucinosa and mycosis fungoides–associated alopecia mucinosa.[11] Although no single criterion is diagnostic,[12] cytologic atypia and a bandlike infiltrate are more common in mycosis fungoides. In addition, Pautrier microabscesses in the epidermis and upper follicle are rarely found in benign alopecia mucinosa but are common in mycosis fungoides. The benign inflammatory process is typically characterized by an infiltrate confined to the follicular, perifollicular, or perivascular zones with no extension of cells into the epidermis or papillary/reticular dermis. On the other hand, the typical infiltrate associated with mycosis fungoides involves the upper dermis invading the epidermis and includes characteristic tumor cells in the damaged follicle, epidermis, and/or dermis.

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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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