Arc-Shaped Furrow on Forehead Extending From Linear Alopecia | Dermatology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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
1.
Arai  S , Katsuoka  K .  Clinical entity of lupus erythematosus panniculitis/lupus erythematosus profundus.   Autoimmun Rev. 2009;8(6):449-452. doi:10.1016/j.autrev.2008.12.011PubMedGoogle ScholarCrossref
2.
Udompanich  S , Chanprapaph  K , Suchonwanit  P .  Linear and annular lupus panniculitis of the scalp: case report with emphasis on trichoscopic findings and review of the literature.   Case Rep Dermatol. 2019;11(2):157-165. doi:10.1159/000500848PubMedGoogle ScholarCrossref
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(3):294-296.PubMedGoogle Scholar
4.
Mitxelena  J , Martínez-Peñuela  A , Cordoba  A , Yanguas  I .  Linear and annular lupus panniculitis of the scalp.   Actas Dermosifiliogr. 2013;104(10):936-939. doi:10.1016/j.ad.2012.12.014PubMedGoogle ScholarCrossref
5.
Park  SK , Yoo  HH , Yun  SK , Kim  HU , Park  J .  Geometric alopecia associated with lupus erythematosus panniculitis of the scalp: a case series of nine Korean patients.   Eur J Dermatol. 2018;28(3):399-400. doi:10.1684/ejd.2018.3269PubMedGoogle Scholar
6.
Lueangarun  S , Subpayasarn  U , Tempark  T .  Distinctive lupus panniculitis of scalp with linear alopecia along Blaschko’s lines: a review of the literature.   Int J Dermatol. 2019;58(2):144-150. doi:10.1111/ijd.14155PubMedGoogle ScholarCrossref
7.
Seitz  CS , Bröcker  EB , Trautmann  A .  Linear variant of chronic cutaneous lupus erythematosus: a clue for the pathogenesis of chronic cutaneous lupus erythematosus?   Lupus. 2008;17(12):1136-1139. doi:10.1177/0961203308092425PubMedGoogle ScholarCrossref
8.
Tan  SK , Tay  YK .  Linear atrophoderma of Moulin.   JAAD Case Rep. 2016;2(1):10-12. doi:10.1016/j.jdcr.2015.10.005PubMedGoogle ScholarCrossref
9.
Navarro-Triviño  FJ , Ortego Centeno  N .  Linear lupus panniculitis of the scalp with good response to thalidomide.   Lupus. 2019;28(11):1380-1382. doi:10.1177/0961203319873703PubMedGoogle ScholarCrossref
10.
Rongioletti  F , Rebora  A .  Annular and semicircular lipoatrophies: report of three cases and review of the literature.   J Am Acad Dermatol. 1989;20(3):433-436. doi:10.1016/S0190-9622(89)70053-0PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close