Quiz

Hair Disorders

Arc-Shaped Furrow on the Forehead Extending From Linear Alopecia on the Vertex

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Dermatology

January 1, 2022

JAMA Dermatology Clinicopathological Challenge

Article Information and Disclosures

Il-Jae Lee, MD¹;

Seok-Kweon Yun, MD, PhD^1,2;

Kyung-Hwa Nam, MD, PhD^1,2

Author Affiliations

¹Department of Dermatology, Jeonbuk National University Medical School, Jeonju, South Korea
²Research Institute of Clinical Medicine and the Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea

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A man in his 50s presented to our dermatology department with an asymptomatic, arc-shaped, depressed skin groove on the left side of his forehead, frontal scalp, and vertex area. Localized linear hair loss and hair thinning on the left scalp area were observed. The patient reported that when the lesion had begun to appear, approximately 10 years earlier, he had received 2 doses of intralesional steroid via injection on a small bald patch on the vertex. Thereafter, the lesion gradually progressed to the frontal scalp and eventually made a linear furrow on the left side of his forehead.

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C. Linear or annular lupus erythematosus panniculitis of the scalp

Histopathologic examination revealed prominent lymphocytic infiltration around the hair follicles and appendages in the dermis, and vacuolar degeneration in the basal layer of the hair follicles without epidermal involvement. In the subcutaneous tissue layer, a lobular lymphocytic infiltrate was present with associated hyaline fat necrosis (Figure, C and D). Abundant mucin deposition in the deep dermis and subcutaneous fat layer were highlighted by Alcian blue staining. Direct immunofluorescence results were positive, with granular deposition of immunoglobulin (Ig) G, IgA, IgM, C3, C1q, and fibrinogen in the dermal blood vessels. All laboratory test findings were normal, including negativity for antinuclear antibody and antidouble-stranded DNA antibody. A diagnosis of lupus erythematosus panniculitis (LEP), specifically linear or annular lupus erythematosus panniculitis of the scalp (LALPS), was made. Slight improvement of the depressed skin lesion was observed with oral hydroxychloroquine (400 mg/d) and topical corticosteroid for 3 months.

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Article Information

Corresponding Author: Kyung-Hwa Nam, MD, PhD, Department of Dermatology, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, South Korea (kyung1212@hanmail.net).

Published Online: November 24, 2021. doi:10.1001/jamadermatol.2021.4714

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting us permission to publish this information.

References

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10.

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Arc-Shaped Furrow on the Forehead Extending From Linear Alopecia on the Vertex

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