Follicular mucinosis - Alopecia mucinosa - Mucinosis follicularis

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What is Alopecia mucinosa?
Follicular mucinosis is also known as alopecia mucinosa or mucinosis follicularis.

Alopecia mucinosa is a rare disorder characterized by mucin deposition (mucinosis) in pilosebaceous follicles and with much less frequency in sebaceous glands. Alopecia mucinosa commonly affects the face, neck and scalp, but any hairy part of the body may be involved. It is usually associated with the loss of hair at the affected follicular sites. Though many treatment options are available, there is no specific standard treatment for mucinosis follicularis.

Causes of follicular mucinosis

There are two forms of the follicular disorder. The primary form is idiopathic with unknown cause. The idiopathic form may undergo spontaneous regression and remission within two months to two years. Idiopathic follicularis is usually encountered in children or adolescents and rarely in adults. The secondary mucinosis follicularis form is usually associated with inflammatory skin diseases such as lupus erythematosus and lichen simplex and neoplastic conditions such cutaneous T-cell lymphoma, Hodgkin's disease and mycosis fungoides. The secondary form usually manifests in the adults.

Differential diagnosis of alopecia mucinosa

Differential diagnosis of follicularis condition is necessary to rule out hives, leprosy, eczema, acne, folliculitis, scarring alopecia and other forms of dermatosis.

Interesting reading: Definition of alopecia | What is alopecia areata | Alopecia areata totalis | Alopecia areata universalis

There is typical accumulation of mucin at the follicular areas and the presence of infiltrates of lymphocytes surrounding and involving follicular epithelium. Histological evaluation is necessary for the confirmation of the mucinosis follicularis. Colloidal iron stains may demonstrate the presence of mucin. Immunohistochemical staining may be used to diagnose the presence of abnormal cells associated with alopecia mucinosa.

Treatment of follicular mucinosis

There are no specific standard treatment for primary alopecia mucinosa. Mucinosis follicularis Treatment with topical, intralesional and systemic corticosteroids show mixed results.

Interesting reading: Dermis layers | Papillary dermis | Reticular dermis | Hypodermis layer | Keratinocyte cells

In some mucinosis follicularis patients photodynamic therapy had been effective. Rajiv Joshi et al reported complete cure of A. mucinosa with standard multidrug therapy (MDT) for leprosy. They treated two patients with a single mucinosis follicularis lesion with MDT for six months. The alopecia mucinosa had completely cleared and follicular growth resumed.

Interesting reading: Layers of epidermis | Stratum granulosum | Stratum lucidum | Stratum spinosum | Stratum basale | Stratum corneum

The authors infer that dapsone in MDT may have cured alopecia mucinosa. Minocycline had cured a few cases of follicular, mucinosis follicularis. Treating the causative disorder may resolve the secondary follicularis.

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References: 1.Marie Lewars, Josh Levin, Stephen Purcell. Follicular mucinosis. Indian Dermatol Online J. 2013;Oct-Dec; 4(4): 333–335. doi: 10.4103/2229-5178.120667 2.Rajiv Joshi, Vinay Gopalani. Alopecia Mucinosa Responding to Antileprosy Treatment: Are we Missing Something?. Indian J Dermatol. 2013;May-Jun; 58(3): 227–231. doi: 10.4103/0019-5154.110834. 3.Paola C. Vieira da Rosa Passos, Manuela Ferrasso Zuchi, Andréa Buosi Fabre, and Luis Eduardo A. Machado Martins. Follicular mucinosis - Case report. An Bras Dermatol. 2014;Mar-Apr; 89(2): 337–339. doi: 10.1590/abd1806-4841.20142968

Current topic in the dynamic natural skin care: Causes of alopecia mucinosa and treatment for follicular mucinosis or follicularis.