Bexarotene reverses alopecia in cutaneous T-cell lymphoma

Sir, Mycosis fungoides (MF) is characterized by clonal helper/memory (CD4+ CD45RO+) T‐cells in the epidermis, whereas follicular mucinosis or alopecia mucinosis has perifollicular T‐cell infiltrates and may clinically resemble alopecia areata.1, 2 Bexarotene is the first retinoid X receptor (RXR)‐selective retinoid shown to be effective for cutaneous T‐cell lymphoma.3, 4 Bexarotene has recently been shown to induce T‐cell apoptosis in vitro.5 Although bexarotene oral and topical gel are effective for MF, this is the first report, to our knowledge, of reversal of associated alopecia. Five patients with alopecia secondary to MF or follicular mucinosis were observed among a cohort of over 90 patients receiving bexarotene therapy at the M.D. Anderson Cancer Center. Their demographic data, degree of hair loss, skin biopsy results and drug administration are shown in Table 1. The location of the hair loss was confined to the scalp in four patients and to the extremities in a fifth. All of the skin biopsy specimens revealed atypical CD4+ CD8+ perifollicular lymphocytic infiltrates, and two showed mucin deposits consistent with follicular mucinosis. Three patients had scaling with negative fungal cultures. Patients with early stage MF were treated with topical bexarotene therapy and advanced stage patients with oral bexarotene. The MF as well as the alopecia improved in all five patients, irrespective of the route of delivery. Hair regrowth began within 2–9 months and full regrowth was evident by 1·5 years.