The spectrum of hair loss in patients with mycosis fungoides and Sézary syndrome.

BACKGROUND Alopecia can be a manifestation of mycosis fungoides (MF) and Sézary syndrome (SS), but the prevalence is unknown. OBJECTIVE We sought to describe the clinicopathologic presentation and molecular features of alopecia in patients with MF/SS. METHODS A retrospective chart review of a prospectively collected MF/SS database was used to identify patients with alopecia. The National Alopecia Areata Registry was used to identify patients with self-reported cutaneous T-cell lymphoma. RESULTS Among 1550 patients with MF/SS, 38 patients with patchy, total-scalp, or universal alopecia were identified. Thirteen of 38 (34%) had patchy alopecia clinically identical to alopecia areata. Scalp biopsy specimens were available in 5 of the 13 patients. Specimens from 4 patients had atypical T lymphocytes within the follicular epithelium or epidermis, and that from two patients had a histology of follicular mucinosis. The remaining 25 of 38 (66%) patients with MF/SS included 20 with alopecia within discreet patch/plaque or follicular lesions of MF and 5 with total-body hair loss, which presented only in those with generalized erythroderma and SS. LIMITATIONS This was a retrospective study done at one cancer center. Biopsy specimens of alopecia were not available for every patient. CONCLUSIONS Alopecia was observed in 2.5% of patients with MF/SS, with alopecia areata-like patchy loss in 34% and alopecia within MF lesions in 66%.