A 72-Year-Old Woman with a Diffuse Erythema, Scaling on the Scalp and Coexisting Hair Loss

Abstract

Mycosis fungoides is the most common primary cutaneous T-cell lymphoma. The pathogenesis of mycosis fungoides remains unclear. The condition is most common in adults over 50 years of age. A male predominance is observed. The clinical presentation of mycosis fungoides varies with the stage of the disease. In the earliest, patchy stage, single or multiple, various in diameter, erythematous, or brownish scaly patches are localized most commonly on the gluteal region and proximal thighs. The plaque stage is characterized by the presence of annular or horseshoe-shaped lesions with an infiltrated base, raised, well-defined edges and asymmetrical distribution. In the tumor stage, erythematous-purplish papules or nodules of larger diameter are detected. Hair loss is observed in 2.5% of patients with mycosis fungoides. It is more common in women compared to men. Hair loss in the course of mycosis fungoides is mainly patchy (84%). However, alopecia totalis or universalis may occur. In same patients, areas of hair loss with normal skin or mild erythema and scaling is observed. In others, hair loss is associated with patchy, plaque or follicular lesions. Diagnosis of mycosis fungoides requires a combination of clinical, pathologic, and molecular features. Treatment of mycosis fungoides depends on the disease’s stage. In early-stages, topical corticosteroids, topical nitrogen mustards, topical bexarotene, imiquimod, psoralen-ultraviolet therapy or ultraviolet B therapy are usually recommended. Local radiation and total skin electron beam therapy may be also useful. For more extensive disease, the various systemic options are available and include retinoids, methotrexate, interferons, targeted immunotherapy and polychemotherapy.