Spiky Follicular Mycosis Fungoides: A Trichoscopic View

Unveiling Spiky Follicular Mycosis Fungoides: A New Trichoscopic Perspective

Lena Voss in Health & Wellness December 2025 • 3 min read.

"Discover how spiky follicular mycosis fungoides presents a unique trichoscopic feature, aiding in early diagnosis and treatment."

Mycosis fungoides (MF) is a type of cutaneous T-cell lymphoma that primarily affects the skin. While the condition typically manifests as patches, plaques, or tumors, there are several variants, including folliculotropic mycosis fungoides (FMF). FMF involves the hair follicles and can present unique diagnostic challenges.

Recently, a case study highlighted an unusual presentation of FMF known as spiky follicular mycosis fungoides. This variant is characterized by hyperkeratotic spiky follicular papules, primarily located on the trunk and extremities. The discovery of this unique dermoscopic feature offers a new perspective for diagnosing and managing this rare condition.

This article delves into the specifics of spiky follicular mycosis fungoides, its clinical presentation, diagnostic approaches, and potential treatment strategies. By understanding this rare variant, healthcare professionals can improve early detection and provide more effective care for affected individuals.

What is Spiky Follicular Mycosis Fungoides?

Spiky Follicular Mycosis Fungoides: A Trichoscopic View

Spiky follicular mycosis fungoides is a rare clinicopathological presentation of FMF, characterized by multiple hyperkeratotic spiky follicular papules. These papules are mainly located on the trunk and extremities, making them distinct from other forms of mycosis fungoides.

A recent case report described a 58-year-old man with no significant medical history who presented with a three-year history of patchy alopecia. Initially misdiagnosed as tinea capitis and treated unsuccessfully with antifungal regimens, the patient's main symptoms were rough skin and mild pruritus.

Clinical examination revealed extensive scalp involvement with hyperkeratotic alopecic patches, infiltrated papules, and cysts.
Multiple erythematous papules and plaques were observed on the trunk and extremities.
Careful inspection revealed numerous yellow millimetric filiform keratotic spicules on the neck and upper back.
The palms and soles were spared.

Histopathological examination of skin samples from the scalp and trunk confirmed the diagnosis of FMF. Trichoscopic examination of the scalp showed thick coats of keratinaceous debris around dilated openings and hair shafts. Keratotic cone-shaped spicules were found surrounding follicular openings on the neck and upper back, corresponding to clinically observed keratotic spiky follicular lesions.

Advancing Diagnosis and Treatment

The identification of spiky follicular mycosis fungoides as a distinct dermoscopic entity enhances our ability to diagnose and treat this rare condition effectively. Further research and case studies will help refine our understanding and improve patient outcomes. By recognizing these unique features, dermatologists can provide more targeted and effective interventions, improving the quality of life for those affected by this challenging condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/jdv.15365, Alternate LINK

Title: Spiky Follicular Mycosis Fungoides: A Trichoscopic Feature

Subject: Infectious Diseases

Journal: Journal of the European Academy of Dermatology and Venereology

Publisher: Wiley

Authors: A. Souissi, I. Ben Lagha, F. Jendoubi, H. Drissi, I. Chelly, M. Mokni

Published: 2019-04-22

Everything You Need To Know

What exactly is Spiky Follicular Mycosis Fungoides?

Spiky Follicular Mycosis Fungoides is a rare presentation of Folliculotropic Mycosis Fungoides (FMF), a variant of Mycosis Fungoides. It's characterized by hyperkeratotic spiky follicular papules, mainly found on the trunk and extremities. This distinct presentation aids in differentiating it from other forms of Mycosis Fungoides.

Why is it important to identify spiky follicular mycosis fungoides as a distinct condition?

The identification of spiky follicular mycosis fungoides is significant as a distinct dermoscopic entity because it enhances the ability to diagnose and treat this rare condition effectively. Recognizing this unique feature enables dermatologists to provide more targeted interventions, which can improve the quality of life for those affected. Furthermore, it prevents misdiagnosis, as seen in the case of the patient initially diagnosed with tinea capitis.

How is Spiky Follicular Mycosis Fungoides diagnosed?

The diagnosis of Spiky Follicular Mycosis Fungoides typically involves a combination of clinical examination, trichoscopic evaluation, and histopathological examination. Clinical examination reveals the presence of hyperkeratotic spiky follicular papules, while trichoscopy helps visualize the keratotic spicules around follicular openings. Histopathology confirms the diagnosis of Folliculotropic Mycosis Fungoides through skin samples. These methods, together, ensure an accurate diagnosis of this rare variant.

What is the relationship between Mycosis Fungoides, Folliculotropic Mycosis Fungoides and Spiky Follicular Mycosis Fungoides?

Mycosis Fungoides (MF) is a type of cutaneous T-cell lymphoma that primarily affects the skin, typically presenting as patches, plaques, or tumors. Folliculotropic Mycosis Fungoides (FMF) is a variant where the disease involves the hair follicles, posing unique diagnostic challenges. Spiky Follicular Mycosis Fungoides is a rare presentation of FMF, characterized by hyperkeratotic spiky follicular papules. While MF broadly affects the skin, FMF specifically targets hair follicles, and Spiky FMF presents a distinct physical manifestation that helps in early detection.

What are the treatment strategies for Spiky Follicular Mycosis Fungoides, and why is early diagnosis important?

While specific treatment strategies aren't detailed, understanding spiky follicular mycosis fungoides allows for more targeted and effective interventions. Early diagnosis is crucial in managing Mycosis Fungoides and its variants. Future research and case studies will further refine our understanding and treatment approaches, potentially leading to improved patient outcomes and quality of life.