O#22   Follicular mycosis fungoides resembling alopecia areata

Antonella Tosti, Bianca Maria Piraccini, Matilde Lorizzo, Cosimo Misciali and Lorenzo Cerroni1. Dept of Dermatology, University of Bologna, Italy; 1Dept of Dermatology, University of Graz, Austria

A 58-year-old man presented with a 2 year history of patchy alopecia resembling alopecia areata on the upper limbs and left eyelid inflammation with loss of the eyelashes. The clinical examination revealed erythematous papules, comedo-like lesions and cysts of the upper and lower left eyelids. The pathology showed a dense dermal infiltrate of lymphocytes with epidermotropism of the cysts epithelium, but not of the epidermis. Several infundibular cysts filled with keratin were evident in the upper dermis. Molecular biology revealed that the infiltrate consisted of monoclonal T lymphocytes. Discussion: This case documents a very rare variety of mycosis fungoides, where alopecia is the result of cysts and comedo formation due to direct mechanical obstruction of the follicle by the dermal infiltrate. Follicular mucinosis, which is usually responsible for alopecia in patients with mycosis fungoides, is not present.