Фолликулярный муциноз (Follicular mucinosis)

Фолликулярный муциноз гистологически характеризуется муцинозной дегенерацией  волосяных фолликулов и сальных желез, вокруг которых развивается инфильтрат, состоящий из лимфоцитов, гистиоцитов и эозинофилов. Очаги поражения представлены эритематозными, инфильтрированными шелушащимися бляшками с подчеркнутым фолликулярным рисунком. Волосы в области бляшек отсутствуют (фолликулярная алопеция). Различают доброкачественный (идиопатический) и симптоматический  распространенный фолликулярный муциноз (при грибовидном микозе).

Доброкачественный фолликулярный муциноз отмечается у молодых людей (в возрасте до 40 лет), проявляется единичными или несколькими ограниченными бляшками, локализующимися на лице, шее и волосистой части головы. Эти очаги фолликулярного муциноза могут разрешиться спонтанно в течение двух лет, но иногда  развивается генерализованная доброкачественная форма, локализующаяся на туловище и конечностях, которая может приобретать хроническое рецидивирующее течение. Фолликулярный муциноз в 15-30% случае сочетается с грибовидным микозом, но он очень редко локализуется на лице, шее и голове.

Специфические методы диагностики:

  • Биопсия кожи
  • При необходимости – иммуногистохимические и молекулярно-биологические исследования (Саузерн-блоттинг).

Лечение доброкачественного (идиопатического) фолликулярного муциноза. Назначают сильные глюкортикостероиды для наружного применения, лучше под окклюзию; внутриочаговое введение глюкокортикостероидов. Применяется также дапсон  в дозе 100 мг/сут в чистом виде или в комбинации с глюкортикостероидами, ПУВА. Отмечен терапевтический эффект от тетрациклина, изотретиноина, индометацина.

Распространенный фолликулярный муциноз  является формой грибовидного микоза. Его лечение поводится по принципам терапии первичных Т-клеточных лимфом кожи.

 

 

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