Elige Jennings posted an update 3 days, 11 hours ago
4. ConclusionAHE is a benign form of leukocytoclastic vasculitis that normally needs supportive therapy and clears without any complications. Infections, mainly upper respiratory tract infections, could possibly be involved in development of such disease. In the child’s case, Rhinovirus is perhaps the trigger for the AHE condition.DisclosureNo conflict of interest.1. IntroductionScalp psoriasis, a disease characterized by sharply demarcated erythematous plaques with overlying scale, affects greater than 2% of the Western world (Van de Kerkhof and Franssen, 2001). Despite the prevalence of scalp psoriasis, very few cases of psoriasis causing scalp central centrifugal cicatricial (scarring) alopecia (CCCA) have been described (Almeida et al., 2013). Psoriatic scalp induced alopecia most commonly is non-cicatricial and affects only lesional skin; however, in addition to a few cases of cicatricial alopecia, it bace inhibitors may also cause a generalized telogen effluvium (George et al., 2015).2. Case reportA 50-year-old female presented to the dermatology clinic for follow-up of a multi-year history of hair loss secondary to recalcitrant CCCA. In the previous years, intralesional steroid injections (Kenalog 10 mg/cc), minoxidil, and Derma-smoothe oil (fluocinolone acetonide) had been used as treatment and had only resulted in intermittent mild improvements in hair loss. Additionally, she had a score of III B on the Seborrhea Area and Severity Index (SASI) scale (Smith et al., 2002). Over time there was progressive hair thinning, scalp pruritus, especially around the hair line, and scalp pain.She was lost to follow-up for two years and upon returning to clinic, she had round, hyperkeratotic plaques with a rim of erythema scattered on the scalp and frontal hairline in the regions of the alopecia (Fig. 1a/b). A biopsy was consistent with psoriasis. The biopsy showed diminished number of terminal hair follicles, as well as naked hair shafts, with associated interstitial and perifollicular fibrosis (Fig. 2). There were also focal areas of granulomatous infiltrate. In the stratum corneum, there were overlying areas of parakeratosis and neutrophils. The periodic acid-Schiff (PAS) stain was negative, ruling out fungal infection (Fig. 3).Hyperkeratotic plaques with rim of erythema on the (a) scalp and (b) frontal… Download high-res image (520KB)Download full-size imageFigure 1. Hyperkeratotic plaques with rim of erythema on the (a) scalp and (b) frontal hairline with some hair regrowth following treatment.H&E shows diminished terminal hair follicles and naked hair shafts with… Download high-res image (570KB)Download full-size imageFigure 2. H&E shows diminished terminal hair follicles and naked hair shafts with associated interstitial and perifollicular fibrosis.H&E also shows overlying parakeratosis and neutrophils in the stratum corneum Download high-res image (709KB)Download full-size imageFigure 3. H&E also shows overlying parakeratosis and neutrophils in the stratum corneum.