Distinguishing Lipedematous Scalp, Lipedematous Alopecia, and Diffuse Alopecia Areata

Abstract

Soft, spongy or doughy consistency of the scalp resulting from thickening of the subcutaneous layer is termed as lipedematous scalp (LS). When such soft, boggy scalp is associated with hair loss, where the scalp hair is no longer than a few centimeters, it is referred as lipedematous alopecia (LA). There have been coincidental reports of androgenetic alopecia, psoriasis, mucinosis, and discoid lupus erythematosus with LS. We report a case of LS and alopecia areata whose characteristic histopathological feature showed a “swarm of bees” appearance and thickening of subcutaneous tissue. The diagnosis of alopecia areata was further confirmed by immunohistochemistry staining of the tissue showing CD3+ T-lymphocytes around the bulb. The aim of this case report is to make readers understand that LA and LS are not different diseases and one needs to rule out other causes of alopecia in order to pick up conditions which are essentially reversible and treatable.

Lipedematous scalp with lipedematous alopecia: A case report

“…Lipedematous alopecia refers to the condition where hair growth abnormalities co-exist with lipedematous scalp. Lipedematous alopecia may be confused with other causes of localised hair loss such as alopecia areata [1]. Herein, we report a case of lipedematous scalp and alopecia present at the same site over the scalp.…”

“…Sahu et al reported concomitant alopecia areata and lipedematous scalp over parietotemporal region of scalp in a 29 year old male [7]. Dhurat et al also described a similar case and emphasized that lipedematous scalp and lipedematous alopecia are not distinct conditions [1].…”

Trichoscopic and imaging study of lipedematous alopecia: report of five cases

“…7 Especially since the majority of social media users are young adults, the question arises whether this group is a growing user of aesthetic treatments such as botox and fillers. 8 According to a 2018 survey by the American Academy of Facial Plastic and Reconstructive Surgery, 72% of facial plastic surgeons saw an increase in cosmetic surgery or injectables in patients under the age of 30. This would be an increase of 24%, compared to 2013.…”

“…The unique finding of a more superficial blood flow with obliteration of the dermal-epidermal junction may help to understand the pathogenesis of these conditions. Deep scalp biopsies and imaging techniques may be helpful to rule out mainly alopecia areata, androgenetic alopecia 8 and other scalp conditions that course with pruritus and erythema such as psoriasis, scalp dermatitis and dermatomyositis. LS and LA may be an expression of the same scalp disorder, with an unclear pathogenesis background and distinctive clinical features.…”

“…LS and LA may be an expression of the same scalp disorder, with an unclear pathogenesis background and distinctive clinical features. 8 The presence of decreased hair density, hair miniaturization and telangiectasia in the trichoscopy associated with LS should point to LA. Besides nonscarring features, LA can show poor hair regrowth and variable therapeutic response.…”