LAUSR

Folliculotoropic mycosis fungoides (MF) is a variant of MF, that clinically shows acneiform or follicular keratosis-pilaris-like lesions on the head and neck, which histologically shows selective infiltration of atypical lymphocytes in the follicular epithelium. Folliculotropic MF shows a more aggressive clinical course in comparison to classic MF [1]. In a recent study, folliculotropic MF was classified into two distinct patterns: an early variant and an advanced tumour variant. The prognostic implications differ, with the early variant following a more indolent course [2]. In an excimer laser, the dissociation of xenon and chloride gases creates a 308-nm monochromatic light, which suppresses T lymphocyte proliferation via the induction of apoptosis [3]. The effectiveness of excimer laser for classic MF has been reported [4]. We herein report a patient with advanced stage folliculotropic MF, who was successfully treated with a combination of bexarotene and excimer laser therapy. A 58-year-old Japanese man presented to our hospital with a skin lesion that had persisted for three months. A physical examination revealed several tumours on his head and face (figure 1A) and erythema with follicular accentuation on his back, abdomen and upper extremities (figure 1B) . A histological examination of a tissue specimen obtained from a head nodule revealed infiltration of atypical small cells around the hair follicles (figure 1C) and prominent folloculotropism. (figure 1 D). Immunohistochemically, the atypical cells were positive for CD3 and CD4 (figure 1E). Clonal rearrangement of the T-cell receptor gene of lymphocytes that had infiltrated into the skin was detected. Blood test findings were almost within normal limits. No atypical lymphocytes were detected. Soluble interleukin-2 receptor level was not elevated (378 U/mL). HTLV-I antibodies were not detected. No lymph node or internal organ abnormalities were detected on positron emission tomography-computed tomography. No bone marrow involvement was observed. Accordingly, the patient was diagnosed with folliculotropic MF (T3N0M0, Stage-b). The patient was initially treated with topical steroids and bexarotene (300 mg/m2). Two weeks later, the skin lesions on the trunk showed slight improvement; however, the tumours showed no change. Therefore, irradiation using an excimer laser (XTRAC® velocity7; STRATA Skin Sciences, Inc., PA) was performed for the remaining erythema and tumours on the face, head and trunk (200 mJ/cm2, three times/week). Thereafter, the skin lesions gradually improved, and completely disappeared at 10 weeks (figure 1F, G). No side effects, except for slight erythema, were observed. The bexaroten and excimer A B