Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings

Abstract

Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

Lichen simplex chronicus on the scalp: Broom fibers on dermoscopy; gear wheel sign and hamburger sign on histopathology

“…[ 2 ] Dermoscopy of the scalp affected by lichen simplex chronicus shows erythema and scaling associated with shaft breakage, at the level of the scalp, into two or three shafts, hence appearing as short hair emerging from the single follicular unit. Such an abnormality is described as “broom fibers.”[ 4 6 ] The present reports revealed broom fibers as well as erythema and perifollicular scaling. The broom hairs identified on dermoscopy have been reported in trichotillomania.…”

“…[ 1 8 ] It mostly affects female patients, with a peak incidence between ages 35 and 50 years. [ 6 ] However, both of our cases were males.…”

“…This hair shaft abnormality has been described as broom hair fibers. [Figure 1b and c ][ 4 5 6 ] Histopathological examination in the horizontal section at the level of infundibulum showed the splitting of hair shaft into two parts, known as hamburger sign [ Figure 1d ]. Based on clinical, dermoscopic, and histopathological correlation a diagnosis of LSC was made.…”

Trichoteiromania: Good Response to Treatment with N-Acetylcysteine

“…Anecdotal reports also mention the use of topical capsaicin, tacrolimus, and doxepin hydrochloride. Psychotherapy is recommended as an adjuvant treatment [3, 18, 19]. …”

Recent advances in the treatment of trichotillomania (hair‐pulling disorder)

“…Histopathological findings include bifid hairs with hyperkeratosis referred to as the "hamburger sign" and acanthotic projections surrounding the affected root sheaths termed as the "gear wheel sign." 15 Trichoteiromania is often treated with high potency glucocorticoid creams, and success is variable. 16 A case report has shown good response to N-acetylcysteine (NAC) treatment in a 47-year-old male who had partial improvement at 8 weeks and complete regrowth of hair at 16 weeks after treatment with 1200 mg of NAC daily.…”