Follicular Mucinosis?

Abstract: 80 yo man with intensely pruritic papules face and neck for 2 months

HPI:  This 80 yo man has a 2 month history of 2 – 3 mm erythematous papules, mostly on face and neck. These are few in number.  A trial cobetasol ointment was without relief.  His medications are: amlodipine, HCTZ, metroprolol, Vytorin (ezetimibe and eimvastatin), Pantoprazole.  He is in good general health.

ClinicalPhotos: These show how subtle the lesions are.

Because of symptoms a Biopsy was done.

Histopath shows: focal erosion and ulceration and ectatic blood vessels.  There is a moderate to dense superficial and deep perivascular perifollicular lymphohistiocytic infiltrate with numerous eosinophils, marked mucin deposition and conspicuous disruption of the follicular epitheliumThe pathologic diagnosis includes, “infectious etiology,” eosinophilic folliculitis, and follicular mucinosis.

Diagnosis:  Acneiform Follicular Mucinosis might be the best fit.

Reference:

Follicular Mucinosis?

Abstract: 27 yo woman with 6 month history of plaques face
HPI: This 27 year-old baker has asymptomatic plaques on the right cheek for six months. She has not been treated as yet.
O/E: Two ill-defined plaques on right cheek. There is a suggestion that follicular openings are dilated.
Clinical Photos:
One can compare the right and left cheeks. Dermoscopic image as well.
Normal left cheek on left, affected right cheek on right.




The image to the right is taken through a dermoscope.
I believe it shows dilated follicular openings.
I am not sure this has been reported.







Diagnosis: Possible Follicular mucinosis

Questions: Do you think this young woman should have a biopsy? Should she be observed? Treated?

Reference:
Gorpelioglu C, Sarifakioglu E, Bayrak R. A case of follicular mucinosis treated successfully with pimecrolimus. Clin Exp Dermatol. 2009 Jan;34(1):86-7.
This paper describes a 24 yo man with biopsy proven follicular mucinosis who was successfully treated with pimecrolimus.