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E-IJD CASE REPORT
Year : 2016  |  Volume : 61  |  Issue : 5  |  Page : 581
Linear non scarring alopecia of the scalp: A rare manifestation of lupus panniculitis


Department of Dermatology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication9-Sep-2016

Correspondence Address:
Sandhyarani Kshetrimayum
Junior Resident, Department of Dermatology, Regional Institute of Medical Sciences Lamphel, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.190133

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   Abstract 


Alopecia in a linear pattern is very rare with only a few cases reported in the medical literature. We report a case of linear non scarring alopecia involving the scalp in a 17-year-old boy with a histological diagnosis of lupus panniculitis. We report this case because of its rarity and also the inclusion of this entity as one of the rare differential of non scarring alopecia.


Keywords: Linear, lupus panniculitis, non scarring alopecia


How to cite this article:
Kshetrimayum S, Thokchom N, Hmar V. Linear non scarring alopecia of the scalp: A rare manifestation of lupus panniculitis. Indian J Dermatol 2016;61:581

How to cite this URL:
Kshetrimayum S, Thokchom N, Hmar V. Linear non scarring alopecia of the scalp: A rare manifestation of lupus panniculitis. Indian J Dermatol [serial online] 2016 [cited 2019 May 19];61:581. Available from: http://www.e-ijd.org/text.asp?2016/61/5/581/190133

What was known?
Lupus panniculitis is a variant of cutaneous lupus erythematosus involving the deep dermis and subcutaneous fat.





   Introduction Top


Linear lesions in dermatology are commonly encountered, but alopecia in a linear pattern is rare. Alopecia of the scalp can be of various shape, from small round patch to total alopecia but only a few cases of linear alopecia have been reported in the medical literature. We recently observed a case of alopecia of the scalp in a linear pattern in 17 year old boy which clinically simulated alopecia areata, but the histopathological diagnosis was compatible with lupus panniculitis (LP).


   Case Report Top


A 17-year-old boy presented to our outpatient department with a history of hairless patches on the scalp in a linear pattern for the past 7 years (age of onset 10 years). Physical examination revealed two alopecic patches measuring 10 cm long and 2 cm wide involving the temporal and frontal scalp [Figure 1]. The lesions were smooth, mildly erythematous, and tenderness was present. Skin biopsy revealed moderate pericapillary lymphocytic infiltration with fat necrosis myxoid degeneration and hyaline deposits in the interlobular septa suggestive of LP [Figure 2] and [Figure 3]. Routine investigations were within normal limit, and antinuclear antibodies (ANAs) was 0.51 (negative). The patient was started on oral prednisolone 20 mg and oral hydroxychloroquine 200 mg twice daily. Follow up at 3 months after treatment [Figure 4].
Figure 1: Patch of non scarring alopecia in a linear pattern

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Figure 2: Moderate pericapillary lymphocytic infiltration with fat necrosis myxoid degeneration and hyaline deposits in the interlobular septa (H and E, ×100)

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Figure 3: Mucin deposition [Alcian blue/Periodic acid-schiff ×100]

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Figure 4: Three months after treatment

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   Discussion Top


LP is a small subset of all cases of cutaneous lupus erythematosus involving the deep dermis and subcutaneous fat, representing 2–3% of this group.[1] LP with a linear pattern is rare with only few case reports in the medical literature. The first case of linear LP involving the leg was reported by Tada et al.[2] in 1991.

The first case of linear LP localized on the scalp was reported by Nagai et al.[3] in 2003. Subsequently, a number of cases have been reported, the majority of it being from East Asia, younger age of onset, male predominance with exclusive involvement of the scalp.[4],[5],[6],[7],[8]

Kossard [8] in 2002 reported a case of LP simulating alopecia areata of a common patchy type in a 27-year-old female with a known case of systemic lupus erythematosus. The author described that the alopecic lesion showed only faint erythema and it rather simulated the lesion of alopecia areata. The present case also simulated alopecia areata clinically, but the findings of erythema and scalp tenderness were distinctive. Alopecia areata commonly manifest as a patch of non scarring alopecia, but annular [9] and linear [10] morphology have been described.

The histopathology findings in linear LP include a predominantly lobular lymphocytic panniculitis with hyaline fat necrosis.[1] In our case, it revealed myxoid degeneration, fat necrosis and hyaline deposits in the interlobular septa with moderate lymphocytic infiltration. This signifies the importance of histological confirmation in aiding to the diagnosis in such unusual manifestation of the disease.

ANA is positive in 70% of cases of LP.[9] ANA was negative in the present case. ANA negativity have also been described in few of the cases of linear LP.[2],[5],[6]

Our diagnosis of LP was made on the grounds of the unusual manifestation of the disease as linear non scarring alopecia with subtle clinical signs such as mild erythema and scalp tenderness and the typical histopathological changes but with negative ANA.

To the best of our knowledge, this is the first case being reported from India. We report this case because of its rarity and the consideration of this entity in the differential diagnosis of non scarring alopecia of the scalp of any shape.


   Conclusion Top


Linear alopecia is a rare and unique manifestation of LP. Clinical pointer to diagnosis in our case was a patch of non scarring alopecia with subtle erythema and scalp tenderness with characteristic histological findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Paterson W. Panniculitis. In: Bolognia JL, Jorizzo JL, Scaffer JV, editors. Dermatology. 3rd ed. Spain: Elsevier Saunders; 2012. p. 1641-62.  Back to cited text no. 1
    
2.
Tada J, Arata J, Katayama H. Linear lupus erythematosus profundus in a child. J Am Acad Dermatol 1991;24 (5 Pt 2):871-4.  Back to cited text no. 2
    
3.
Nagai Y, Ishikawa O, Hattori T, Ogawa T. Linear lupus erythematosus profundus on the scalp following the lines of Blaschko. Eur J Dermatol 2003;13:294-6.  Back to cited text no. 3
[PUBMED]    
4.
Rhee CH, Kim SM, Kim MH, Cinn YW, Ihm CW. Two cases of linear alopecia on the occipital scalp. Ann Dermatol 2009;21:159-63.  Back to cited text no. 4
[PUBMED]    
5.
Shin MK, Cho TH, Lew BL, Sim WY. A case of linear lupus erythematosus profundus on the scalp presenting as alopecia. Korean J Dermatol 2007;45:1280-3.  Back to cited text no. 5
    
6.
Chen YA, Hsu CK, Lee JY, Yang CC. Linear lupus panniculitis of the scalp presenting as alopecia along Blaschko's lines: A distinct variant of lupus panniculitis in East Asians? J Dermatol 2012;39:385-8.  Back to cited text no. 6
[PUBMED]    
7.
Tsuzaka S, Ishiguro N, Akashi R, Kawashima M. A case of lupus erythematosus profundus with multiple arc-shaped erythematous plaques on the scalp and a review of the literature. Lupus 2012;21:662-5.  Back to cited text no. 7
[PUBMED]    
8.
Kossard S. Lupus panniculitis clinically simulating alopecia areata. Australas J Dermatol 2002;43:221-3.  Back to cited text no. 8
[PUBMED]    
9.
Bansal M, Manchanda K, Pandey S. Annular alopecia areata: Report of two cases. Int J Trichology 2013;5:91-3.  Back to cited text no. 9
[PUBMED]    
10.
Seetharam KA. Alopecia areata: An update. Indian J Dermatol Venereol Leprol 2013;79:563-75.  Back to cited text no. 10
[PUBMED]  Medknow Journal  

What is new?
Lupus panniculitis should be considered as a differential in a case of non scarring alopecia of any shape.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

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