The diagnosis was comedonal folliculotropic mycosis fungoides (FMF). The authors point out that follicular lesions, including comedones, are a very typical presentation of FMF. What was unusual about this case was the fact that widespread comedones as the sole and initial manifestation of FMF is exceedingly rare.
Involvement of the eyebrows is highly characteristic in FMF and may present as an early disease manifestation as well as a useful clue in the differential diagnosis. The authors describe how epidermotropic plaque lesions developing in this patient after many years of comedonal lesions are considered to be indicative of an aggressive course and poor survival in the early stage of the disease.
Treatment for this patient was with was with pegylated interferon alpha-2a and oral isotretinoin. The addition of isotretinoin helps to normalize follicular keratinization, which prevents the formation of new comedo-like lesions. The patient partially benefited from this dual therapy. He experienced hair regrowth and the comedo-like lesions have decreased.
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Paolino G et al. Widespread and eruptive comedonal lesions with alopecia. JAAD Case Rep . 2022 Nov 1;31:23-26.