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Editorial |

Pilotropic Mycosis Fungoides A Clinicopathologic Variant of Mycosis Fungoides Yet to Be Completely Understood

Lorenzo Cerroni, MD
Arch Dermatol. 2010;146(6):662-664. doi:10.1001/archdermatol.2010.93.
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In this issue of the Archives, Lehman et al1 report the findings of a single-center study about pilotropic mycosis fungoides (MF), systematically reviewing the pertinent medical literature. The study confirms previous articles about poor prognosis associated with this variant of MF2,3 and presents some new data, particularly concerning the histopathologic features of this disease. One notable aspect described by Lehman et al is the frequent presence of syringotropism, found in 56% of patients with pilotropic MF in their study. This percentage is much higher than the percentages reported by van Doorn et al,2 Gerami et al,3 and Gerami and Guitart4 and confirms previous observations that involvement of both the hair follicles and the eccrine glands may be observed in one and the same lesion of MF.5 The fact that syringotropic MF is often associated with pilotropism is confirmed by the common clinical presence of concomitant alopecia in affected areas of the skin. Lehman et al, on the other hand, demonstrated that the opposite is also true, namely, that pilotropic MF is commonly associated with syringotropism as well. Therefore, these 2 adnexotropic variants of MF are probably strictly related, possibly reflecting the involvement of lymphocytes with peculiar tropism for epithelial adnexal structures.6

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Figure 1.

Original clinical picture of the patient described by Giovannini8 in 1906.

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Figure 2.

Photomicrographs of alopecia areata of the 13-year-old girl described by Giovannini8 in 1906. Note dense folliculotropic infiltrates and a small infundibular cyst in Figure 6, features typical of pilotropic mycosis fungoides. Giovannini wrote: “To the best of my knowledge, there has been no previous description of the cystic involution of the sebaceous glands and of the onset of milia in pre-mycotic eruptions. . . . ”8(p19)

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