Widespread and Eruptive Comedonal Lesions With Alopecia
November 2022
in “
JAAD case reports
”
comedones alopecia follicular infundibulum keratotic plugging perifollicular CD4-predominant atypical T-lymphocytic infiltrate comedonal folliculotropic mycosis fungoides epidermotropic plaques pegylated interferon alpha-2a isotretinoin follicular keratinization sebaceous glands anti-inflammatory properties hair loss follicle keratin plug Accutane anti-inflammatory
TLDR A man with skin and hair symptoms improved partially with specific treatment.
A 68-year-old man presented with a 2-year history of widespread comedones and patchy alopecia. Histopathology showed a dilated, follicular infundibulum with keratotic plugging and a perifollicular band-like CD4-predominant atypical T-lymphocytic infiltrate. The most likely diagnosis was comedonal folliculotropic mycosis fungoides (FMF), a rare condition where follicular lesions, including comedones, are the typical presentation. The development of epidermotropic plaques in the patient after a longstanding comedonal eruption was seen as a sign of poor prognosis. The best treatment for this patient was a combination of pegylated interferon alpha-2a and isotretinoin, which normalized follicular keratinization, prevented the formation of new comedo-like lesions, reduced the secretion of the sebaceous glands, and had anti-inflammatory properties. The patient partially benefited from this therapy; his hair regrew and the comedo-like components decreased.
