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Follicular mucinosis Systemic Lupus erythematosus Hair loss Prof. Bhushan Kumar, Head, Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160 012 (India) A 37-year-old man presented with loss of hair on asymptomatic erythematous boggy plaques over the scalp, face, trunk and limbs of 8 months duration. A provisional diagnosis of follicular mucinosis was made. It was confirmed by histopathological examination of the skin biopsy (Alcian blue stain) which revealed mucinous deposits in the dermis, especially around hair follicles and sebaceous glands with destruction of these structures. Direct immunoíiuorescence from peri-lesional skin did not exhibit immune deposits. Routine investigations were within normal limits. There was considerable cosmetic disfigurement due to the lesions. The patient was treated with oral pred-nisolone 40 mg once daily with marked improvement within 6 weeks. The patient was lost to follow-up for about a year and he then presented with fever, malar erythema, periorbital and bilateral pedal oedema and painless palatal erosions. The old lesions of follicular mucinosis were inactive. He had no systemic symptoms except decreased urine output. Urine examination revealed albuminuria and microscopic hae-maturia. Twenty-four-hour urine demonstrated proteinuria of non-nephrotic range. Serum urea and creatinine were 140 and 2.7 mg/dl, respectively. A systemic lupus erythematosus (SLE) work-up showed the presence of LE cells, strongly positive ANF (homogenous pattern) and decreased serum C3. A kidney biopsy revealed features of diffuse proliferative lupus glomerulonephritis with deposition of IgG, IgM and C3 on direct immunofluorescence. A lupus band test of photopro-tected and photo-exposed areas of skin was negative. Histopathology of the previous skin biopsy site did not reveal any mucin deposit. A diagnosis of SLE with renal involvement was made, and the patient was managed with monthly cyclophosphamide (1 g) given intravenously along with 60 mg of prednisolone daily. Discussion Alopecia mucinosa or follicular mucinosis was first described by Pinkus [1] in 1957. It may be associated with a host of benign or lymphoproliferative conditions [2, 3]. Some authors regard follicular mucinosis as a non-specific follicular reaction [4] since mucin deposits have been reported in other disorders, though clinically papular or nodular mucin deposits in these patients are uncommon [5]. Papulonodular mucinosis associated with SLE has been described as a