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LETTER TO THE EDITOR
Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 196-198

A case of folliculotropic mycosis fungoides successfully treated with topical steroid treatment


Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan

Date of Submission24-Jan-2017
Date of Decision15-Jul-2017
Date of Acceptance25-Feb-2018
Date of Web Publication18-Jul-2017

Correspondence Address:
Tomomitsu Miyagaki
Department of Dermatology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_75_17

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How to cite this article:
Numajiri H, Miyagaki T, Sugaya M, Sato S. A case of folliculotropic mycosis fungoides successfully treated with topical steroid treatment. J Can Res Ther 2020;16:196-8

How to cite this URL:
Numajiri H, Miyagaki T, Sugaya M, Sato S. A case of folliculotropic mycosis fungoides successfully treated with topical steroid treatment. J Can Res Ther [serial online] 2020 [cited 2020 Jun 6];16:196-8. Available from: http://www.cancerjournal.net/text.asp?2020/16/1/196/230445



Sir,

Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) that has distinct clinical and histologic features. Multiple groups have reported that FMF has an aggressive clinical course comparable to that of tumor stage of MF.[1],[2] Recent reports, however, suggested that a group of patients with FMF had a good prognosis.[3],[4],[5] Here, we report a case of FMF successfully treated with topical steroid treatment.

A 50-year-old Japanese male was referred to our hospital with a 1-month history of erythematous plaques with pruritus on his face. The patient had a history of atopic dermatitis from childhood. At presentation, severely pruritic, coin-sized, indurated, erythematous plaques were scattered on his face [Figure 1] and [Figure 2]. His blood tests showed only mild elevation of liver enzymes. Skin biopsy revealed dermal perifollicular infiltration of lymphocytes with folliculotropism [Figure 3]. Immunohistochemical study showed that infiltrated lymphocytes were mostly positive for CD3 and CD4 but negative for CD7, CD8, CD20, and CD30 [Figure 4], [Figure 5], [Figure 6]. In addition, mucin deposition in the hair follicles was confirmed by alcian blue staining. A monoclonal T-cell receptor rearrangement was detected by polymerase chain reaction. A computed tomography scan showed no evidence of lymph node or internal organ involvement. Considering these findings above, we diagnosed him as having FMF. He received topical steroid treatment (prednisolone valerate acetate), and his skin eruptions disappeared within 1 month. No recurrence has been observed for the past 1 year after the cessation of symptoms.
Figure 1: Clinical manifestations. Severely pruritic, coin-sized, indurated, erythematous plaques on his face

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Figure 2: Enlarged picture of Figure 1

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Figure 3: Skin biopsy of the erythematous plaque demonstrating perivascular and perifollicular lymphocytic infiltration in the dermis with folliculotropism (H and E, ×40)

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Figure 4: Immunohistochemical staining for CD4 revealing that dermal infiltrating lymphocytes were positive for CD4

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Figure 5: Immunohistochemical staining for CD7 revealing that dermal infiltrating lymphocytes were negative for CD7

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Figure 6: Immunohistochemical staining for CD8 revealing that dermal infiltrating lymphocytes were negative for CD8

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A possible diagnosis of the skin lesions included atopic dermatitis, follicular mucinosis, and FMF. Mild nuclear atypia of infiltrated lymphocytes in the follicles, lack of CD7 expression, a very high CD4/CD8 ratio, and the detection of T-cell monoclonality supported the diagnosis of FMF. Among numerous variants of MF, FMF has been reported to be less responsive to treatment and has a worse prognosis.[1],[2] Skin-directed therapy alone was proposed to be inadequate in most cases of FMF. On the other hand, our case was successfully treated with topical steroid treatment. Recently, two different groups reported that there was a group of patients with good prognosis similar to early-stage MF among FMF patients.[3],[4],[5] Hodak et al . reported that good-prognosis group was characterized by preferential distribution of lesions in trunk/limbs, less pruritus, less infiltration of perifollicular lymphocytes, less vertical depth, and less frequent eosinophil infiltration.[3] Histopathologically, features of our case are similar to those of the good-prognosis group but clinically consistent with typical FMF. On the other hand, van Santen et al . revealed that patients with early plaques characterized by sparse perifollicular and/or few intrafollicular infiltrates with small atypical lymphocytes, also had a good prognosis, in addition to patients with only early skin lesions such as patches and papules,[4],[5] consistent with our findings. Thus, histopathological findings are important to determine the prognosis of the FMF patients, especially patients with plaques. It is essential that treatment for MF should be determined by considering age, clinical manifestations, histology, previous treatment, and response to the first therapy and that overtreatment should be avoided.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Gerami P, Rosen S, Kuzel T, Boone SL, Guitart J. Folliculotropic mycosis fungoides: An aggressive variant of cutaneous T-cell lymphoma. Arch Dermatol 2008;144:738-46.  Back to cited text no. 1
    
2.
Lehman JS, Cook-Norris RH, Weed BR, Weenig RH, Gibson LE, Weaver AL, et al. Folliculotropic mycosis fungoides: Single-center study and systematic review. Arch Dermatol 2010;146:607-13.  Back to cited text no. 2
    
3.
Hodak E, Amitay-Laish I, Atzmony L, Prag-Naveh H, Yanichkin N, Barzilai A, et al. New insights into folliculotropic mycosis fungoides (FMF): A single-center experience. J Am Acad Dermatol 2016;75:347-55.  Back to cited text no. 3
    
4.
van Santen S, Roach RE, van Doorn R, Horváth B, Bruijn MS, Sanders CJ, et al. Clinical staging and prognostic factors in folliculotropic mycosis fungoides. JAMA Dermatol 2016;152:992-1000.  Back to cited text no. 4
    
5.
van Santen S, van Doorn R, Neelis KJ, Daniëls LA, Horváth B, Bruijn MS, et al. Recommendations for treatment in folliculotropic mycosis fungoides: Report of the Dutch Cutaneous Lymphoma Group. Br J Dermatol 2017;177:223-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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