Boggy Scalp.

INTRODUCTION

A 45-year-old Caucasian woman presented to our outpatient clinic with a 6-year history of scalp tenderness and hair loss. She was otherwise healthy except for a history of urolithiasis. A dermatological examination revealed diffuse nonscarring alopecia over frontoparietal and vertex regions [Figures 1 and 2]. On palpation, the scalp was midly tender and a soft, spongy swelling was present [Figure 3]. The hair pull test and trichogram findings were normal. Histology of a lesional skin biopsy revealed mild perifollicular fibrosis, dilated lymphatics, thickening of collagen bundles, increased subcutaneous adipose tissue, and mild mucin deposition [Figures 4–7].

Figure 1

Nonscarring alopecia over frontoparietal and vertex regions

Figure 2

Boggy swelling of the scalp with indented appearance in the hairline

Figure 3

The scalp could be easily squeezed with cotton swabs

Figure 4

Mild fibrosis around appendages, dilated lymphatics in the upper dermis (H and E, ×40)

Figure 7

Mild mucin deposition in superficial dermis (Alcian blue/ periodic acid–Schiff, ×60)

Mild fibrosis around appendages, dilated lymphatics in the upper dermis (H and E, ×60)

Increased subcutaneous adipose tissue and thickening of collagen bundles in deep dermis and subcutaneous tissue (H and E, ×100)

ANSWER

Lipedematous alopecia.

DISCUSSION

Lipedematous alopecia (LA) is an extremely rare disease, which is characterized by thickened and boggy scalp accompanied by nonscarring alopecia. Up to now, a limited number of cases have been described in the literature, of whom a significant percent are women of African American descent. LA and lipedematous scalp are considered as the two spectra of the same condition. It was Coskey who first coined the term “lipedematous alopecia' to define two cases of “an increase in the thickness of the subcutaneous layer of the scalp and inability to grow hairs longer than 2 cm.”[1],[2],[3],[4],[5]

In the literature, the reports of LA are so rare that the data about LA are limited. However, since LA most commonly affects women of African-American descent, it has been suggested that racial and hormonal factors play the primary roles in the etiopathogenesis of this unique condition. Although the underlying mechanisms do not seem to be related with lymphatic or venous insufficiency, some authors have suggested that lymphatic vessel dilation could be responsible for LA. The main histopathological finding in LA is the increased scalp thickness resulting from expansion of the subcutaneous fat layer in the absence of adipose tissue hypertrophy or hyperplasia.[1],[2],[3],[4],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.