Check sweat glands, hair follicles in mycosis fungoides

SAN FRANCISCO – Check for syringotropism and folliculotropism in biopsies when managing mycosis fungoides, based on data from an ongoing observational, prospective study at Thomas Jefferson University in Philadelphia.

The presence of syringotropism and folliculotropism indicates the need for more aggressive treatment, according to lead investigator Dr. Joya Sahu, of the department of dermatology at the university.

Mycosis fungoides – the most common form of cutaneous T-cell lymphoma – is usually thought to favor the epidermis, but investigators at Thomas Jefferson University have found that it often works its tentacles deeper into the skin to attack hair follicles (folliculotropism) or eccrine glands (syringotropism), Dr. Sahu said at the annual meeting of the American Academy of Dermatology.

The researchers checked biopsy samples to see how common those variants were in 34 new patients with mycosis fungoides (most with stage 1 disease). Overall, 18 (52.9%) had folliculotropism, 22 (64.7%) had syringotropism, and 15 (44.1%) had both.

Not surprisingly, deeper penetration indicated worse disease, Dr. Sahu said. On the modified Severity Weighted Assessment tool (mSWAT) – a measure of surface area involvement and lesion severity – the mean scores were 57.51 in patients with folliculotropism, 59.4 in patients with syringotropism, and 66.4 in patients with both. The higher mSWAT scores also correlated with more severe pruritus and the likelihood that the patient had tried four or more treatments. By contrast, the nine patients without folliculotropism or syringotropism, who had a mean mSWAT score of 16.85, had tried only one or two treatments.

Almost all of the cases presented classically; two had head and neck lesions or other signs of folliculotropic disease, and both of these patients had folliculotropism and syringotropism on biopsy. None of the patients had a syringotropic presentation.

“The majority of patients studied exhibited either folliculotropism or syringotropism, implying greater prevalence,” Dr. Sahu said. “These presentations also have findings indicative of more severe disease. We propose that histopathology reports on patients with suspected [mycosis fungoides] should document the presence of folliculotropism and syringotropism as they may aid in diagnosis and in predicting severity and progression risk,” she noted.

She cautioned, however, that her clinic is a tertiary referral center, and as such might see patients with more severe disease, compared with other clinics.

The patients were otherwise typical of the mycosis fungoides population, she said. About two-thirds were men, and the average age was 63 years.

Dr. Sahu said she had no relevant financial conflicts of interest.

[email protected]

SAN FRANCISCO – Check for syringotropism and folliculotropism in biopsies when managing mycosis fungoides, based on data from an ongoing observational, prospective study at Thomas Jefferson University in Philadelphia.

The presence of syringotropism and folliculotropism indicates the need for more aggressive treatment, according to lead investigator Dr. Joya Sahu, of the department of dermatology at the university.

Mycosis fungoides – the most common form of cutaneous T-cell lymphoma – is usually thought to favor the epidermis, but investigators at Thomas Jefferson University have found that it often works its tentacles deeper into the skin to attack hair follicles (folliculotropism) or eccrine glands (syringotropism), Dr. Sahu said at the annual meeting of the American Academy of Dermatology.

The researchers checked biopsy samples to see how common those variants were in 34 new patients with mycosis fungoides (most with stage 1 disease). Overall, 18 (52.9%) had folliculotropism, 22 (64.7%) had syringotropism, and 15 (44.1%) had both.

Not surprisingly, deeper penetration indicated worse disease, Dr. Sahu said. On the modified Severity Weighted Assessment tool (mSWAT) – a measure of surface area involvement and lesion severity – the mean scores were 57.51 in patients with folliculotropism, 59.4 in patients with syringotropism, and 66.4 in patients with both. The higher mSWAT scores also correlated with more severe pruritus and the likelihood that the patient had tried four or more treatments. By contrast, the nine patients without folliculotropism or syringotropism, who had a mean mSWAT score of 16.85, had tried only one or two treatments.

Almost all of the cases presented classically; two had head and neck lesions or other signs of folliculotropic disease, and both of these patients had folliculotropism and syringotropism on biopsy. None of the patients had a syringotropic presentation.

“The majority of patients studied exhibited either folliculotropism or syringotropism, implying greater prevalence,” Dr. Sahu said. “These presentations also have findings indicative of more severe disease. We propose that histopathology reports on patients with suspected [mycosis fungoides] should document the presence of folliculotropism and syringotropism as they may aid in diagnosis and in predicting severity and progression risk,” she noted.

She cautioned, however, that her clinic is a tertiary referral center, and as such might see patients with more severe disease, compared with other clinics.

The patients were otherwise typical of the mycosis fungoides population, she said. About two-thirds were men, and the average age was 63 years.

Dr. Sahu said she had no relevant financial conflicts of interest.

[email protected]

SAN FRANCISCO – Check for syringotropism and folliculotropism in biopsies when managing mycosis fungoides, based on data from an ongoing observational, prospective study at Thomas Jefferson University in Philadelphia.

The presence of syringotropism and folliculotropism indicates the need for more aggressive treatment, according to lead investigator Dr. Joya Sahu, of the department of dermatology at the university.

Mycosis fungoides – the most common form of cutaneous T-cell lymphoma – is usually thought to favor the epidermis, but investigators at Thomas Jefferson University have found that it often works its tentacles deeper into the skin to attack hair follicles (folliculotropism) or eccrine glands (syringotropism), Dr. Sahu said at the annual meeting of the American Academy of Dermatology.

The researchers checked biopsy samples to see how common those variants were in 34 new patients with mycosis fungoides (most with stage 1 disease). Overall, 18 (52.9%) had folliculotropism, 22 (64.7%) had syringotropism, and 15 (44.1%) had both.

Not surprisingly, deeper penetration indicated worse disease, Dr. Sahu said. On the modified Severity Weighted Assessment tool (mSWAT) – a measure of surface area involvement and lesion severity – the mean scores were 57.51 in patients with folliculotropism, 59.4 in patients with syringotropism, and 66.4 in patients with both. The higher mSWAT scores also correlated with more severe pruritus and the likelihood that the patient had tried four or more treatments. By contrast, the nine patients without folliculotropism or syringotropism, who had a mean mSWAT score of 16.85, had tried only one or two treatments.

Almost all of the cases presented classically; two had head and neck lesions or other signs of folliculotropic disease, and both of these patients had folliculotropism and syringotropism on biopsy. None of the patients had a syringotropic presentation.

“The majority of patients studied exhibited either folliculotropism or syringotropism, implying greater prevalence,” Dr. Sahu said. “These presentations also have findings indicative of more severe disease. We propose that histopathology reports on patients with suspected [mycosis fungoides] should document the presence of folliculotropism and syringotropism as they may aid in diagnosis and in predicting severity and progression risk,” she noted.

She cautioned, however, that her clinic is a tertiary referral center, and as such might see patients with more severe disease, compared with other clinics.

The patients were otherwise typical of the mycosis fungoides population, she said. About two-thirds were men, and the average age was 63 years.

Dr. Sahu said she had no relevant financial conflicts of interest.

[email protected]