CASE REPORT
A 68-year-old Japanese man with a reddish plaque on the forehead for
several years and alopecia on the scalp for 9 months was referred to our
department. A physical examination revealed alopecic reddish plaques
measuring 3 cm in diameter on the forehead and scalp (Figure 1a). Lymph
nodes were not swollen around the head or neck. A dermoscopic
examination of the reddish plaque on the forehead showed multiple round
brownish yellow dots with a whitish rim in the follicular ostium and red
dots in the interfollicular area (Figure 1b). A peripheral blood
examination revealed no increases in the level of the soluble
interleukin 2 receptor or the number of atypical lymphocytes. A
histopathological examination with hematoxylin & eosin staining showed
i) an eosinophilic substance in the dilated infundibulum and a pale
basophilic substance in the isthmus and outer root sheath (Figure 1c),
ii) focal follicular spongiosis and vacuolar alterations at the
interface between the outer root sheath and the dermis, iii) the
follicular and perifollicular infiltration of lymphocytes without
atypia, and iv) dilated capillary vessels in the upper dermis. The
substance deposited in the hair follicle was stained with Alcian blue at
pH 2.5 (Figure 1d). Based on the findings obtained, the patient was
diagnosed with idiopathic follicular mucinosis and the relevant
alopecia. The patient was treated 4 times each month with triamcinolone
acetonide injections, with resulted in the attenuation of lesions after
4 months (Figure 1e).