A Rare Case of Scarring Alopecia-FOLLICULOTROPIC MYCOSIS FUNGOIDES

Summary: The patient is married female 54 years of age , and presented with an itchy skin rash and loss of scalp and eyebrow hair for the past 2 years. She had scarring alopecia involving 80 % surface area of the scalp , boggy on palpation, with residual hypo and hyperpigmentation and multiple comedones, . Both ears showed giant comedones and on the face multiple erythematous follicular hyperkeratotic papule coalesced to form plaques. There was hyperpigmentation, scratch marks, comedones and cysts on the trunk, abdomen and limbs. The largest nodular plaque measured 3x 3 cm Skin Biopsy for histopathology shows perifollicular and intrafollicular atypical lymphocytes with destruction of hair follicles and no epidermotropism. Mucinous degeneration of follicular epithelium can be demonstrated on Alcian blue stain. Immunohistochemistry revealed CD3 +/ CD4 + / CD 7 – /CD8 -T cells. For staging of the disease and formulation of further plan of management investigations were carried out that showed no visceral , nodal or peripheral blood involvement , therefore making it Stage T3, N0, M0, B0 and Clinical Stage II B. She was advised Methotrexate , Folic acid , Minocycline , Hydroxyzine , Clobetasol ointment , with Phototherapy and has shown significant improvement.