Alopecia Mucinosa Responding to Antileprosy Treatment: Are we Missing Something?
A 12-year-old girl presented in March 2009, with hair loss over left eyebrow and dry hypopigmented skin of adjacent forehead. The skin lesion and hair loss had been present for about 3 months and was gradually progressive. Sensations were mildly impaired over the site but no thickened nerve was palpable. A clinical diagnosis of leprosy was considered and she was asked to apply a moisturizing cream and kept under observation as a biopsy was refused. A month later the patch had enlarged minimally, the surface was dry and showed follicular prominences, however, no erythema was seen []. She agreed to a biopsy and a 3 mm punch biopsy was performed from the patch just above the left eyebrow. The biopsy showed a moderately dense superficial and mid perivascular infiltrate of lymphocytes with occasional eosinophils without any granulomas in the sections. Few of the follicular infundibula showed features of follicular mucinosis with mild spongiosis, separation of the keratinocytes from one another, and clear spaces between the keratinocytes, which contained wisps of light blue-gray mucin. Staining with Alcian blue revealed small quantities of bluish mucin [Figures -].\nBased on clinical suspicion of leprosy and because of increase in the size of the patch she was prescribed MDT, Rifampicin 300 mg once a month, and dapsone 50 mg daily as her weight was 30.5 kg. The treatment was, however, started a month later as she was in her village for the summer holidays. On follow-up 1 month after starting MDT, that is, in June 2009, the hypopigmented patch was still present, but had stopped increasing in size, the follicular prominences had flattened and some regrowth of hair was seen which continued through the next month. Her hemoglobin had fallen to below 9 gm/dl (G6PD was normal) so dapsone was reduced to 100 mg once a week and clofazimine 50 mg daily was introduced. Follow up in September 09, 3.5 months after starting of MDT showed faint hypopigmentation with indistinct margins. She completed 6 months of MDT in December 2009, at which time the lesion had cleared completely with regrowth of all hair [].