Dermoscopic and trichoscopic features of follicular mycosis fungoides: a systematic review.

Abstract

Introduction: Folliculotropic mycosis fungoides (FMF) is a distinctive variant of mycosis fungoides (MF). FMF has worse clinical outcome when compared to the MF and commonly used skin-based therapy may be refractory. The aim of this study is to give a systematic review of dermoscopic and trichoscopic findings in FMF and to summarize current knowledge on usefulness of dermoscopy in patients with FMF.

Evidence acquisition: A search of the literature was performed using the electronic database PubMed by selecting the words "dermoscopy," "dermatoscopy," "trichoscopy," and "follicular mycosis fungoides."

Evidence synthesis: After exclusion criteria, 10 articles in total were included in this review. Among 10 selected articles, a total number of 59 patients were included, and total of 23 dermoscopic features were described. Only seven of 23 dermoscopic features were present in over half of the patients (over 30 in total number of 59 patients). Among obtained results, only five dermoscopic features were found in more than 70% of the patients; but none of these were described in majority of the patients. Among these published papers, the dermoscopic features of cutaneous lymphomas were correlated with the histopathology.

Conclusions: After reviewing all these papers we can conclude that dermoscopic features related to the pathology found in follicle, although characteristic, are not pathognomonic when it comes to diagnosing FMF. A finding of multiple characteristic dermoscopic features is required to indicate a diagnosis of FMF but in the corresponding clinical context. In some cases, dermoscopy can be used as a useful tool for determining optimal biopsy site with the potential of increasing specificity of pathohistological diagnosis which is crucial because of choice of the therapeutic approach having in mind that FMF is more refractory to the conventional treatment of MF.