spiny hyperkeratosis-like follicular mycosis fungoides: a case report

Folliculotropic mycosis fungoides (fmf) is a rare variant of cutaneous t-cell lymphoma which is categorized as a separate entity. in histopathology, malignant lymphocytes selectively surround and infiltrate hair follicles. fmf has different clinical features in comparison with classic mf which is more refractory to treatment and has a worse prognosis.in the current study, we describe a 42-year-old patient presenting as follicular papules with keratotic spines and alopecia on the scalp, face, and trunk. histologic examination of the patient’s biopsy revealed follicular and perifollicular t lymphoid cell infiltration without follicular mucinosis. clonality analysis was interpreted as cd4+ t cell lymphoproliferative disorder. with the final diagnosis of fmf, the patient underwent treatment with oral acitretin and topical corticosteroid and psoralen plus ultraviolet a (puva). this case, in addition to the accompanied review of literature, revealed the importance of considering fmf in spiny hyperkeratotic papules in seborrheic areas refractory to antifungal treatments.