Alopecia Mucinosa Responding to Antileprosy Treatment: Are we Missing Something?
A 22-year-old Indian male, studying in the USA, presented in December 2010, with a 6 month history of a single gradually enlarging erythematous plaque on the left forehead of 4 × 3 cm size with mild hypoesthesia []. No thickened nerves were palpable. Three months back he had a skin biopsy in the USA and diagnosed as follicular mucinosis with folliculotropic mycosis fungoides. The biopsy sections showed accumulation of mucin in all follicles in the sections and a fairly dense lymphocytic infiltrate with several eosinophils. Lymphocytes were seen infiltrating the follicular epithelium but no atypical lymphocytes were seen. No granulomas were seen. Immunohistochemistry showed the infiltrating lymphocytes to be CD3 and CD4 positive. The T cell receptor (TCR) gene rearrangement studies done in USA had been reported as indeterminate. He had been advised topical Tretinoin and Deoximetasone creams, which he used without any improvement over 3 months.\nHe gave a history of childhood atopic dermatitis with mild asthma but was off all medications since several years. His baseline blood investigations repeated in India were normal except for eosinophilia of 21%. With the good response to MDT in the previous 2 cases it was decided to start him also on MDT, however, as he was shortly returning to the USA, he was started on ROM therapy (rifampicin 600 mg, ofloxacin 400 mg, minocycline 100 mg) to be taken once a month for 6 months. The skin lesion had completely healed after 3-4 months of starting the treatment. The patient completed all six doses of ROM, and has not had recurrence in the ensuing 1 year.