title: Clinical and histopathologic spectrum of alopecia mucinosa/follicular mucinosis and its natural history in children.
abstract: BACKGROUND
  Some authorities consider alopecia mucinosa (AM)/follicular mucinosis (FM) to invariably represent mycosis fungoides (MF). This understanding of AM/FM derives from observations in adults.
  
  
  OBJECTIVE
  We sought to explore the clinicopathologic features and natural history of pediatric AM/FM.
  
  
  METHODS
  Medical records were searched for children given the diagnosis of AM/FM from 1998 through 2009. Diagnosis of AM/FM was defined as the presence of well-demarcated hairless plaques with follicular prominence plus an abundance of mucin on histopathologic examination.
  
  
  RESULTS
  Forty children with a clinical diagnosis of AM/FM were identified. Nine did not meet the inclusion criteria. In the 31 remaining cases (16 boys, 15 girls) the mean age at onset was 9 ± 3.5 years. Histopathologic examination showed folliculotropism in 28 patients (90%) and epidermotropism in 15 (48%). Twelve cases fulfilled the International Society of Cutaneous Lymphomas (ISCL) diagnostic criteria for early MF. The histopathologic findings were typical of MF in only in two of these cases. T-cell receptor gene rearrangement was positive in 3 of 6 (50%) of tested samples, one in a patient who fulfilled the ISCL criteria for early MF. Mean duration of follow-up was 6.2 ± 3.7 years. All skin lesions resolved and none persisted or recurred. Hodgkin lymphoma was diagnosed 6 months after diagnosis of AM/FM in one patient.
  
  
  CONCLUSIONS
  This was a retrospective study.
  
  
  CONCLUSIONS
  Although some pediatric cases meet the diagnostic criteria for MF, AM/FM cannot be regarded unequivocally as early follicular MF in this age group. We suggest the current diagnostic criteria for early MF should exclude children with AM/FM. Long-term follow-up of children with AM/FM is nevertheless warranted.
authors.affiliation: Unit of Pediatric Dermatology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. azvulun@bgu.ac.il
authors.forename: Alex
authors.initials: A
authors.lastname: Zvulunov
authors.forename: Vered
authors.initials: V
authors.lastname: Shkalim
authors.forename: Dan
authors.initials: D
authors.lastname: Ben-Amitai
authors.forename: Meora
authors.initials: M
authors.lastname: Feinmesser
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D000507:Mucinosis, Follicular / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies