Prominent Follicular Mucinosis With Diffuse Scalp Alopecia Resembling Alopecia Areata

In 2013, a 56-year-old Caucasian female presented with a 2-month history of rapidly progressing alopecia, initially starting with discrete patches and evolving into diffuse scalp hair loss. Histopathological examination revealed an inflammatory nonscarring alopecia with prominent follicular mucinosis, a condition where mucin accumulates in hair follicles, and findings suggestive of alopecia areata, an autoimmune condition characterized by hair loss. The patient's alopecia resolved completely after treatment with oral prednisone. The histopathologic findings and clinical presentation led to a diagnosis of alopecia areata with secondary follicular mucinosis. However, the differential diagnosis was broad, and follicular mucinosis can be associated with both benign and malignant conditions, necessitating careful clinical diagnosis. This case was the second reported instance of alopecia areata with secondary follicular mucinosis, and due to the potential association with T-cell lymphoproliferative disorders, ongoing clinical follow-up with regular skin examinations was recommended for the patient.