Alopecia Mucinosa Responding to Antileprosy Treatment: Are we Missing Something?
A 14-year-old boy presented in September 2007, with a hypopigmented and hypoaesthetic shiny patch on the left cheek of few months duration. A clinical diagnosis of leprosy was considered and a 3 mm punch biopsy sample revealed features of follicular mucinosis with most follicles in the sections showing spaces between keratinocytes containing wisps of bluish mucin. Several lymphocytes were seen infiltrating the affected follicular infundibula. The upper and mid dermis had a moderately dense perivascular lymphocytic infiltrate with few eosinophils. No granulomas were seen.\nAlthough a definite histological diagnosis of leprosy could not be rendered, based on the clinical suspicion the patient was started on MDT, with Rifampicin 450 mg once a month and dapsone 100 mg daily according to the standard World Health Organization (WHO) protocol. He was followed-up at monthly intervals and at the end of 6 months, the lesion had cleared significantly, although not completely and the treatment was stopped. Subsequently the lesion was seen to have completely cleared at follow up at the end of 1 and 2 years.