Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Jun;11(3):296-301.
doi: 10.1159/000543256. Epub 2024 Dec 28.

Alopecia Mimicking Lichen Planopilaris in a Patient with Mycosis Fungoides

Daniel Asz-Sigall  1 , Marysol Macedo Perez  2 , Rosa María Lacy-Niebla  2 , Carlos Barrera-Ochoa  1 , Roberto Arenas  3 , Sonia Toussaint-Caire  4 , Diana Santamaría-Domínguez  2 , Diana Valeria Guerrero-Hernández  4 , Irene M Rodríguez-Escamilla  4 , Eduardo Corona-Rodarte  5
Affiliations
Case Reports

Alopecia Mimicking Lichen Planopilaris in a Patient with Mycosis Fungoides

Daniel Asz-Sigall et al. Skin Appendage Disord. 2025 Jun.

Abstract

Introduction: Mycosis fungoides (MF), the most common form of primary cutaneous T-cell lymphoma, can present with diverse clinical manifestations, including alopecia that mimics conditions such as alopecia areata (AA) and lichen planopilaris (LPP). The folliculotropic variant (FMF) poses diagnostic challenges due to overlapping clinical features, necessitating histopathological evaluation for accurate diagnosis.

Case report: A 58-year-old woman with a 21-year history of stage IB MF developed alopecic patches in the left temporoparietal region, accompanied by pruritus and trichodynia. Physical examination revealed scarring and non-scarring alopecic patches, while trichoscopy showed characteristic features of follicular involvement. Histological analysis confirmed a diagnosis of FMF, characterized by atypical lymphocytic infiltrate and follicular destruction. Treatment included maintenance of NB-UVB and isotretinoin, with the addition of monthly intralesional corticosteroid injections, resulting in symptomatic improvement.

Discussion/conclusion: This case highlights the diagnostic challenges posed by FMF mimicking AA and LPP. The overlap in clinical and trichoscopic findings underscores the necessity for histopathological evaluation to confirm FMF and differentiate it from other alopecic conditions. Early recognition and a multidisciplinary approach to treatment are crucial for improving outcomes in patients with this aggressive variant of MF.

Keywords: Alopecia; Alopecia areata; Dermoscopy; Folliculotropic mycosis fungoides; Hair diseases; Lichen planopilaris; Mycosis fungoides; Non-scarring alopecia; Scarring alopecia; Trichoscopy.

PubMed Disclaimer

Conflict of interest statement

All authors have no conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Alopecic patches with irregular margins resembling “footprints in the snow.”
Fig. 2.
Fig. 2.
Trichoscopic features. a Scales-crusts and perifollicular scale (red circle). b Dystrophic hair (black circle) and white structureless area (black star). c Spermatozoa-like pattern vessels (black arrow).
Fig. 3.
Fig. 3.
Atypical lymphocytic infiltrate in the papillary dermis, with irregular hyperchromatic nuclei, perinuclear halos, epidermotropism (a), Darier-Pautrier microabscesses (b), and folliculotropism with follicular destruction (c).
Fig. 4.
Fig. 4.
Mild hair regrowth with sparse, fine, short hairs in previously alopecic areas after treatment.
See this image and copyright information in PMC

References

    1. Sidiropoulou P, Nikolaou V, Marinos L, Voudouri D, Komini E, Economidi A, et al. The different faces of mycosis fungoides: results of a single-center study. Int J Dermatol. 2020;59(3):314–20. - PubMed
    1. Pileri A, Agostinelli C, Bruni F, Grandi V, Alessandrini A, Pimpinelli N, et al. Alopecia areata-like mycosis fungoides: lions for lambs. G Ital Dermatol Venereol. 2018;153(2):293–5. - PubMed
    1. Gu AK, Shi J, Zhang Y. Folliculotropic mycosis fungoides. JAMA Dermatol. 2022;158(3):316. - PubMed
    1. Bagot M. Folliculotropic mycosis fungoides is a heterogenous group. Br J Dermatol. 2017;177(1):17–8. - PubMed
    1. Hassan ML, Chaparro E, Waiman J, Moliné J, Moreno A, Endre J, et al. Micosis fungoide foliculotropa. Análisis y evolución de 6 casos. Med Cutan Iber Lat Am. 2013;41(3):103–10.

Publication types

LinkOut - more resources