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%.