LIPEDEMATOUS SCALP

By Gary M. White, MD


Lipedematous scalp (LS) is a rare condition of the scalp characterized by thickening of the subcutaneous layer. The main presenting sign can be dysesthesias. When hair loss occurs, the term lipedematous alopecia (LA) is used.

Clinical

An asymptomatic, boggy, soft, doughy thickening of the scalp, usually in a woman, across the vertex and occiput is characteristic. There may be pain, paresthesias, tenderness, itching, headache, and burning. When alopecia is present, it usually starts in the vertex and spreads centrifugally. It can affect the whole scalp. In some patients, the hair may grow, but only a few centimeters.

Histopathology primarily shows thickening of the subcutaneous layer. Other features include perivascular and periadnexal lymphocytic infiltrate associated with hyperkeratosis, follicular plugging and follicular fibrosis.

Treatment

There is no uniformly effective treatment for the alopecia. Topical and IL corticosteroids, as well as hydroxychloroquine have been tried without much benefit. Oral mycophenolate mofetil 1 gram/day caused complete regrowth in a 50-year-old man [Acta Derm Venereol 2015; 95: 1011–1012].

References

A 57-year-old lady presented with itching and swelling over the scalp for 2 years. She had a diffusely thickened scalp thrown into involutions. The scalp had a boggy and spongy consistency. Indian J Dermatol Venereol Leprol 2014;80:270-2

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