Case Number : Case 1615 - 2 September Posted By: Guest

Interesting. There is mild acanthosis associated with compact hyperkeratosis alternating with orthokeratosis. Mild epidermal spongiosis is also evident, associated with a mild-moderate perivascular lymphocytic infiltrate in the upper dermis. There is obviously a follicular spongiosis with lymphocyte exocytosis and follicular mucin. However the lymphocytes aren't atypical. I think the mucin is secondary. I think this is just follicular mucinosis on the background of chronic atopic dermatitis. 

The histology does indeed show mild compact hyperkeratosis, mild acanthosis, a lack of epidermal spongiosis, prominent follicular mucinosis with exocytosis of some mildly convoluted lymphocytes.  The cells in the epithelium were positive for CD3, CD5 and mainly CD4 (compared with CD8) with some loss of CD2 and CD7. Gene re-arrangement studies were weakly polyclonal for TRG and non-amplifying for TRB studies. We are suspicious that this will be a case of secondary follicular mucinosis to CTCL/mycosis fungoides rather than idiopathic but follow-up will be required for a final conclusion. Thank you to Werner Kempf and Hesham El-Daly who were consulted on this case and the latter for arranging additional studies.  Dr Kempf indicated that there was a report that oral minocycline can be effective in idiopathic follicular mucinosis.