Follicular mucinosis
A 5-year-old girl child presented with a two-year history of a non-pruritic, occasionally scaly spots initially present on the back, which spread to involve the trunk. The child was otherwise healthy with a past medical history of atopic dermatitis and no previous surgeries. Her medications included: multi-vitamin, fish oil, and vitamin D.\nIn her family history, her mother had seasonal allergies and father had hypertension and basal cell carcinoma.\nUpon examination, there were orange-tan, patches with follicular papules involving the trunk [Figures and ]. At that time, no laboratory tests were ordered. Previous biopsies completed in 2010 and early 2012 showed “Conspicuous patchy infiltrates of lymphocytes associated with hair follicles at the level of the infundibulum and isthmus, associated with mild focal follicular spongiosis and vacuolar alteration of the interface between the outer root sheath and the dermis. Additional findings include lymphocytes that are sparse superficial perivascular and intraepidermal, a rare necrotic keratinocyte, and focal smudging of the dermoepidermal junction.” Another biopsy of the upper and lower back was performed on 02/16/2012 and showed the following: “The findings in these two specimens are identical to those in the previous biopsies, with lymphocytic infiltrates that surround, and involve, follicular infundibular and isthmic epithelium [Figures –]. Associated follicular epithelial spongiosis is, for the most part, mild, though there is focal spongiosis that may be graded as moderate. Colloidal iron stains at multiple levels from both specimens demonstrate mucin, both within the infundibular epithelium and the perifollicular sheath. Immunohistochemical stains performed on Specimen “2” (Upper back) reveal a mild loss of CD7 positivity (approximately 40% of cells staining overall), when compared with CD3, CD2, and CD5, CD4 and CD8 stains reveal an overall helper: Suppressor ratio of approximately 5:1, while CD45RO and CD45RB appear to stain cells in both compartments in a roughly equal fashion.” Upper back: “molecular gene rearrangements negative.” The diagnosis: Follicular mucinosis.