Lipedematous Alopecia: Clinical, Histopathological, and Trichoscopic Findings of a Single Case and Review of the Literature

Lipedematous Scalp: Presentation of a Rare Dermatological Condition

Lipedematous scalp (LS) and lipedematous alopecia (LA) are uncommon dermatological conditions characterized by lipid accumulation within scalp tissue, leading to a thickened and boggy scalp. While the exact cause remains elusive, these conditions are believed to be on a spectrum of the same underlying disease process. LS/LA patients can experience dysesthesia of the scalp, but LA is associated with additional hair growth abnormalities. The pathogenesis remains poorly understood, with some cases suggesting a link to hormone leptin dysregulation and/or hyperlipidemia. We present a 73-year-old African American female with a medical history of hypertension, hyperlipidemia, and partial thyroidectomy who presented to the clinic with a two-week history of an itchy, burning 'rash' on the scalp. Physical examination showed normal hair density, but palpation revealed scalp edema and diffuse bogginess. While blood tests were mostly normal, she had an elevated antinuclear antibodies (ANA) titer (1:160). A punch biopsy revealed lichenification, but subsequent non-contrast magnetic resonance angiography (MRA) showed increased scalp fat tissue measuring up to 11 mm, confirming the diagnosis of LS. The patient was reassured that this finding was benign; however, she continued to experience dysesthesia. Our patient experienced minimal relief with topical steroids, leading to the consideration of intralesional steroid injections. The case highlights the importance of recognizing and managing LS as a distinct dermatological entity that requires further research to elucidate underlying mechanisms and establish standardized treatment protocols for this condition.

Ultrasound Is Not Useful in Monitoring Lipedematous Alopecia: A Clinical, Trichoscopic, Histologic, and Ultrasound Analysis of 2 Cases

Introduction: Lipedematous scalp (LS) is a rare condition characterized by thickened adipose tissue in the subcutaneous layer of the scalp resulting in a soft, spongy, or thick consistency of the scalp. When associated with hair loss, this condition is called lipedematous alopecia (LA). Various imaging modalities have been used to diagnose LS and LA along with histopathology. Case Presentation: We present 2 cases of LS: a 56-year-old female with a 1-year history of hair thinning, pain, and tenderness at the vertex scalp and a 60-year-old female with a 5-year history of lichen planopilaris presenting with a 1-year history of itching and soreness on the crown of her head. Ultrasound (US) was used for diagnosis, treatment response surveillance, routine clinical examination, and symptom assessment. Follow-up US revealed no improvement in scalp thickness in either case despite symptom improvement and visual improvement in hair growth. Discussion/Conclusion: US has been reported as a helpful tool in the diagnosis of LS; however, treatment response was better approximated by hair growth and symptom alleviation. We found that once the diagnosis with made with US, clinical monitoring is adequate as symptom improvement and hair growth may not correlate with a change in scalp thickness.