Alopecia Mimicking Lichen Planopilaris in a Patient with Mycosis Fungoides

Mycosis fungoides (MF), the most common form of primary cutaneous T-cell lymphoma, can present with diverse clinical manifestations, including alopecia that mimics conditions such as alopecia areata (AA) and lichen planopilaris (LPP). The folliculotropic variant (FMF) poses diagnostic challenges due to overlapping clinical features, necessitating histopathological evaluation for accurate diagnosis.

A 58-year-old woman with a 21-year history of stage IB MF developed alopecic patches in the left temporoparietal region, accompanied by pruritus and trichodynia. Physical examination revealed scarring and non-scarring alopecic patches, while trichoscopy showed characteristic features of follicular involvement. Histological analysis confirmed a diagnosis of FMF, characterized by atypical lymphocytic infiltrate and follicular destruction. Treatment included maintenance of NB-UVB and isotretinoin, with the addition of monthly intralesional corticosteroid injections, resulting in symptomatic improvement.

This case highlights the diagnostic challenges posed by FMF mimicking AA and LPP. The overlap in clinical and trichoscopic findings underscores the necessity for histopathological evaluation to confirm FMF and differentiate it from other alopecic conditions. Early recognition and a multidisciplinary approach to treatment are crucial for improving outcomes in patients with this aggressive variant of MF.