Follicular Mucinosis Associated With Nonlymphoid Skin Conditions

Abstract

Background: Follicular mucinosis coexisting with lymphoproliferative disorders has been thoroughly debated. However, it has been rarely reported in association with inflammatory disorders.Methods: Thirteen cases have been retrieved, and those with cutaneous lymphoma or alopecia mucinosa were excluded.Results: It was found follicular mucinosis in the setting of squamous cell carcinoma, seborrheic keratosis, simple prurigo, acne vulgaris, dextrometorphan-induced phototoxicity, polymorphous light eruption (2 cases), insect bite (2 cases), tick bite, discoid lupus erythematosus, drug-related vasculitis, and demodecidosis. Unexpectedly, our observations revealed a preponderating accumulation of mucin related to photo-exposed areas, sun-associated dermatoses, and histopathologic solar elastosis. The amount of mucin filling the follicles apparently correlated with the intensity of perifollicular inflammatory infiltrate, which was present in all cases. The concurrence of dermal interstitial mucin was found in 7 cases (54%). Conclusions:The concurrence of interstitial dermal mucinosis or the potential role of both ultraviolet radiation and the perifollicular inflammatory infiltrates in its pathogenesis deserves further investigations. Precise recognition and understanding of this distinctive reactive histological pattern may prevent our patients from unnecessary diagnostic and therapeutic strategies.

Follicular mucinosis in patients with hematologic malignancies other than mycosis fungoides: A clinicopathologic study

“…Mir-Bonafé et al reported on a series of thirteen cases with FM associated with nonlymphoid skin conditions, mainly inflammatory disorders, emphasizing that FM is a reactive histological pattern that can be seen unrelatedly to CTCL. 1 In our study of FM in a population of cancer center patients, FM was unrelated to CTCL in 51% of the cases and none of these 46 patients developed CTCL after a mean follow-up of 4.3 years. Our findings support the concept that FM should not be considered as a variant of MF or a precursor stage of CTCL as previously suggested.…”

“…Clinically, FM presents as follicular prominence, acneiform eruption and focal hair loss. FM in association with various systemic conditions including hematological malignancies, hematopoietic stem cell transplantation (HSCT), and other malignant and benign skin disorders 1 has been occasionally reported. However, it is typically reported in the context of cutaneous T-cell lymphomas (CTCL), specifically folliculotropic mycosis fungoides (MF).…”

Mucinosis folicular. Tres escenarios para su enfoque

“…3 En este contexto, ante un hallazgo histopatológico de mucinosis folicular, el dermatólogo debe evaluar la posibilidad de que su paciente tenga una entidad clínicamente definida, cuya fisiopatología o comportamiento biológico explique el hallazgo de mucinosis folicular en la biopsia. Algunas de estas entidades pueden ser: linfoma cutáneo de células T; micosis fungoide principalmente, leucemia linfocítica crónica, linfoma cutáneo de células B, leucemia mieloide aguda y crónica, macroglobulinemia, linfosarcomas y entidades de carácter inflamatorio o infeccioso como prúrigo simple, erupción solar polimorfa, lupus discoide, vasculitis asociada a medicamentos, demodecidosis 4 foliculitis eosinofílica asociada a VIH, leishmaniasis, lepra, sarcoidosis, alopecia areata, liquen simple, liquen plano, liquen estriado, acné, entre otras. 5 Quienes han sostenido esta discusión en la literatura, ya sea a favor o en contra de la mucinosis folicular como hallazgo histológico sin ser una entidad per se, proponen que estos pacientes deben seguirse estrechamente.…”

“…5 Quienes han sostenido esta discusión en la literatura, ya sea a favor o en contra de la mucinosis folicular como hallazgo histológico sin ser una entidad per se, proponen que estos pacientes deben seguirse estrechamente. 3,4,6 Segundo escenario Mucinosis folicular como entidad per se. Este escenario correspondería a las denominadas formas idiopáticas o benignas, que son las más frecuentes, y se presentan como mucinosis folicular aguda localizada; se manifiestan como una o dos lesiones en cabeza y cuero cabelludo, en niños y adultos jóvenes.…”

Infliximab‐induced follicular mucinosis of the face

“…We suspected a drug‐induced FM secondary to infliximab. Drug‐induced FM has been described in association with imatinib, oxcarbamazepine, captopril, and dextromethorphan . The onset of FM after several months of infliximab, resolution following the withdrawal of therapy, and evidence of infliximab‐induced ANA conversion suggested a fundamental role of pharmacologic TNF‐alpha blockade.…”