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Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Anna Waśkiel-Burnat, Lidia Rudnicka, Małgorzata Olszewska, Adriana Rakowska, Ralph M. Trüeb, Isabel Kolm
Follicular mucinosis (Figure 11e.8) is an uncommon condition, presenting clinically as follicular papules or plaques with associated hair loss, most commonly on the face, neck, and scalp. Using trichoscopy, follicular mucin presents as follicular plugs of amorphous material in dilated follicular ostia. The disease may be primary (idiopathic) or secondary to mycosis fungoides and a number of other diseases.
Non-melanoma skin cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Stephen L. Morris, Sean Whittaker, Margaret Spittle
This variant is characterized by the presence of folliculotropic infiltrates, often sparing the epidermis, and preferential involvement of the head and neck area. Most cases show mucinous degeneration of the hair follicles (follicular mucinosis). The most relevant feature is the deep localization of the neoplastic infiltrate that makes it less accessible to skin-directed therapies.
Cutaneous lymphomas
Published in Franco Cavalli, Harald Stein, Emanuele Zucca, Extranodal Lymphomas, 2008
Reinhard Dummer, Elaine S Jaffe
The folliculotropic variant of MF often spares the epidermis, but instead shows preferential involvement of the hair follicles, particularly on the face and head. Follicular mucinosis is a common feature and in most instances follicular mucinosis represents the folliculotropic variant of MF. Folliculotropic MF has a poorer prognosis than the classical plaque type of MF.7
Classification and recommended treatment options for folliculotropic mycosis fungoides
Published in Expert Opinion on Orphan Drugs, 2018
Suzanne van Santen, Maarten H. Vermeer, Rein Willemze
In 1906, Giovanni already described a 13-year-old patient with MF showing prominent involvement of the hair follicles and associated alopecia [5]. However, the history of FMF actually starts in 1957, when Pinkus introduced the term alopecia mucinosa for a benign reactive disease process that was clinically characterized by follicle-based patches or plaques showing alopecia, and histologically by the presence of mucin deposits in hair follicles and sebaceous glands and a variably dense inflammatory infiltrate [6]. Since the diagnosis was particularly based on the presence of mucin deposits in the hair follicle and alopecia was not always present, Jablonska et al. suggested the term follicular mucinosis for this condition [7]. It was soon recognized that follicular mucinosis does not only occur in alopecia mucinosa, also referred to as the benign or idiopathic form of follicular mucinosis, but can also be found in other skin diseases, in particular in MF (MF-associated follicular mucinosis) [8]. Differentiation between idiopathic and MF-associated follicular mucinosis can sometimes be difficult and the question whether they should be considered as two completely different conditions or as the two ends of a disease spectrum is still a matter of debate [9]. In 1996, Vergier et al. introduced the term pilotropic MF for cases presenting with follicular lesions histologically characterized by infiltration of hair follicle epithelium by neoplastic T cells (folliculotropism), but without the presence of follicular mucinosis [10]. While previous studies had focused particularly on the differentiation between idiopathic and MF-associated follicular mucinosis, van Doorn et al. focused on differences between FMF and classic MF. It was found that patients with FMF had distinctive clinicopathologic features, were more refractory to several standard SDTs and had a worse prognosis than classic type MF. It was therefore suggested that FMF, with or without associated follicular mucinosis, is a distinct disease entity [2]. These observations were confirmed by several other studies [3,4] and in recent cutaneous lymphoma classifications FMF has therefore been included as a distinct variant of MF [1]. Since SDTs were often inadequate and the prognosis was found to be roughly similar to that of tumor-stage classic MF, it was suggested that patients with FMF should be treated accordingly with more aggressive therapies [2,3]. However, more recent studies defined a subgroup of FMF patients with an indolent clinical behavior and an excellent prognosis [11,12]. These studies indicate that not all patients with FMF run an aggressive clinical course and that indolent and aggressive subgroups of FMF may require a different therapeutic approach.