A rare eyebrow skin condition known as follicular mucinosis can serve as a crucial early warning sign of classic Hodgkin lymphoma. Researchers detailed the case of a 26-year-old man whose localized eyebrow hair loss and scaling led to the unexpected diagnosis of stage IIB systemic cancer, highlighting the vital link between dermatologic findings and internal lymphoproliferative disorders.
In the reported case, the patient initially sought medical evaluation after developing a hypopigmented, infiltrated plaque on his right eyebrow accompanied by swollen neck lymph nodes and weight loss. While skin changes like follicular mucinosis are typically associated with cutaneous T-cell lymphomas, their presentation alongside Hodgkin lymphoma remains exceptionally rare. Unexplained localized eyebrow lesions with scaling should prompt a comprehensive systemic evaluation if accompanied by constitutional symptoms.
In Plain English: The Clinical Takeaway
- Follicular Mucinosis: A rare skin reaction where acid mucin builds up inside hair follicles, causing inflammation, scaling, and localized hair loss known as pseudoalopecia.
- Classic Hodgkin Lymphoma: A type of cancer originating in the lymphatic system, characterized by abnormal large cells called Reed-Sternberg cells.
- Systemic Screening: When unusual skin plaques are accompanied by unexplained weight loss or swollen lymph nodes, doctors must look beyond the skin surface to rule out internal malignancies.
Dermatologic Presentation and Diagnostic Workup of the Eyebrow Plaque
The patient’s clinical journey began when he developed localized scaling on his right eyebrow, followed rapidly by progressive hair loss and a hypopigmented patch. Dermatologic examination revealed a 2.2 by 2.0 centimeter infiltrated plaque with irregular borders. Dermoscopy of the affected area uncovered reduced hair density, multidirectional hairs, central whitish scale, and a distinctive feature known as the “toothpaste sign”—whitish material protruding through follicular openings.
Initial differential diagnoses included more common dermatologic conditions such as alopecia areata, lichen sclerosus, and seborrheic dermatitis. The infiltration and follicular scaling prompted a skin biopsy. Histopathologic examination using hematoxylin-eosin and Alcian blue staining confirmed the deposition of acid mucin within the outer root sheath of the hair follicles, establishing the definitive diagnosis of follicular mucinosis.
Detecting Extensive Lymphadenopathy Through Imaging and Biopsy
Because the patient presented with concomitant cervical lymphadenopathy and reported unquantified weight loss, clinicians ordered broader laboratory and imaging studies. Blood tests revealed a mild anemia with a hemoglobin level of 12.2 grams per deciliter and an elevated lactate dehydrogenase level of 268.7 units per liter. Contrast-enhanced computed tomography of the neck, chest, and abdomen exposed extensive lymphadenopathy, including mediastinal nodal conglomerates causing approximately 50 percent narrowing of the superior vena cava.
An excisional lymph node biopsy performed in late April 2025 revealed an atypical lymphoid proliferation with a nodular architecture separated by broad fibrous bands. Immunohistochemistry demonstrated that the large neoplastic cells expressed CD30 and CD15 while remaining negative for CD3 and Epstein-Barr virus latent membrane protein 1. These pathological findings confirmed classic Hodgkin lymphoma of the nodular sclerosis subtype, categorized as Ann Arbor stage IIB.
| Diagnostic Parameter | Initial Clinical Finding | Confirmatory Test Result |
|---|---|---|
| Skin Lesion | Right eyebrow pseudoalopecic plaque | Alcian blue stain confirmed follicular mucinosis |
| Lymph Nodes | Cervical lymphadenopathy | Nodular sclerosis classic Hodgkin lymphoma |
| Biomarkers | Elevated lactate dehydrogenase (268.7 U/L) | CD30 and CD15 positive immunohistochemistry |
| Staging | Approximately 50 percent narrowing of the superior vena cava | Ann Arbor stage IIB; complete metabolic response on subsequent PET/CT |
Achieving Complete Metabolic Response with Combination Chemotherapy
Following the hematologic diagnosis, the patient began combination chemotherapy consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine. By the fifth cycle, clinical evaluation showed complete resolution of the eyebrow hypopigmentation, infiltration, and scaling, accompanied by full regrowth of the eyebrow hair. He completed a total of seven cycles of chemotherapy.
Subsequent positron emission tomography and computed tomography imaging demonstrated residual mediastinal lymph nodes measuring up to 27 millimeters with a maximum standardized uptake value of 1.7, corresponding to a Lugano-Deauville score of 2. This indicated a complete metabolic response to therapy. The patient remains under follow-up at the institute and under the care of the Hematology Department; the most recent imaging evaluation was performed in July 2026.
