Although no single criterion is diagnostic, cytologic atypia and a band-like infiltrate are more common in mycosis fungoides. Also, Pautrier microabscesses in the epidermis and upper follicle are rarely found in benign alopecia mucinosa but are common in mycosis fungoides. No uniformly effective therapy exists for alopecia mucinosa, although several treatments are routinely used. Treatments include topical, intralesional and systemic corticosteroids. In addition, topical and systemic PUVA therapy, topical nitrogen mustard and radiation therapy have demonstrated some success.
Isolated cases document the beneficial responses of dapsone, indomethacin and interferons.
Due to the variable course of the disease and the chance of spontaneous resolution, therapeutic efficacy is difficult to prove. Primary chronic disease usually lingers for several years but can fluctuate in the extent of skin involvement at any given time. Secondary alopecia mucinosa has the least favorable prognosis when associated with coexistent malignancy. Although the question of whether alopecia mucinosa is a transitional state evolving into mycosis fungoides is unresolved, it is proven that alopecia mucinosa may precede the development of mycosis fungoides by several years. Thus, additional biopsy specimens and extremely close follow-up are crucial in all variants of alopecia mucinosa.