International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
 
 
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   
 


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 244-246  

Alopecic and aseptic nodules of the scalp with a chronic relapsing course


1 Department of Medicine, Basra Medical College; Division of Dermatology, Al-Sadr Teaching Hospital; Basra Training Center of Iraqi and Arab Board in Dermatology and Venereology, Basra, Iraq
2 Division of Dermatology, Al-Sadr Teaching Hospital, Basra, Iraq

Date of Web Publication14-Jan-2020

Correspondence Address:
Dr. Anwar Qais Saadoon
Division of Dermatology, Al-Sadr Teaching Hospital, Basra
Iraq
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_106_19

Rights and Permissions
   Abstract 


Alopecic and aseptic nodules of the scalp (AANS) is a relatively new and little-known entity, and thus may possibly be underdiagnosed. This condition was first described in Japan by Iwata et al., in 1992. This disease occurs mainly in young males and is characterized by the presence of aseptic nodular scalp lesions associated with nonscarring alopecia that may resolve within 3 months. Here, we are reporting a case of AANS with a chronic relapsing course. To the best of our knowledge, this is the first case of this rare entity that has been reported in Iraq. We are urged to report this case due to the following factors: a paucity of reports in the literature (to date, fewer than 90 cases have been reported worldwide), an uncanny resemblance to other entities – especially, dissecting cellulitis of the scalp and alopecia areata – and the unusual chronic relapsing course of the disease.

Keywords: Alopecic and aseptic nodules of the scalp, nonscarring alopecia, pseudocyst of the scalp


How to cite this article:
Al-Hamdi KI, Saadoon AQ. Alopecic and aseptic nodules of the scalp with a chronic relapsing course. Int J Trichol 2019;11:244-6

How to cite this URL:
Al-Hamdi KI, Saadoon AQ. Alopecic and aseptic nodules of the scalp with a chronic relapsing course. Int J Trichol [serial online] 2019 [cited 2020 Sep 23];11:244-6. Available from: http://www.ijtrichology.com/text.asp?2019/11/6/244/275954




   Introduction Top


Alopecic and aseptic nodules of the scalp (AANS) is a possibly underdiagnosed condition occurs mainly in young males and is characterized by the presence of aseptic nodular scalp lesions associated with nonscarring alopecia.[1],[2] The etiology of this condition is presently unknown; however, the prognosis is good.[3],[4] Here, we are reporting a case of AANS with a chronic relapsing course.


   Case Report Top


A 27-year-old Iraqi man presented to our outpatient clinic at Al-Sadr Teaching Hospital with a 2-week history of a nodular scalp lesion on the occiput associated with a circumscribed area of hair loss. In the past 6 years, the patient had recurrent episodes of the same lesion, usually appearing as single or multiple, firm, tender nodules, enlarging in size to reach 2.5–3 cm in diameter, and then becoming less tender and fluctuating, accompanied by alopecia on the surface, all within a span of 3–4 weeks. Alopecia is nonscarring, and regrowth often occurs within 2–3 months after resolution of the nodule.

Examination of the patient's scalp showed a single, firm, tender, skin-colored, and dome-shaped nodule of 2 cm in diameter on the upper part of the occipital area. There was also an alopecic area of 2 cm in diameter, resulting from a resolved nodule 2 months earlier [Figure 1]. The surrounding scalp was normal.
Figure 1: Posterior view of the patient's scalp showed an alopecic patch with some regrowth of hair 2 months after resolution of the fluctuating nodule at the same site

Click here to view


Trichoscopic examination was performed [Figure 2], and a biopsy from the firm nodule showed mixed inflammatory infiltrate in the deep dermis, including neutrophils, lymphocytes, and numerous plasma cells [Figure 3]a and [Figure 3]b. Cultures of the punctured material were negative. Serological tests for syphilis (venereal disease research laboratory and  Treponema pallidum Scientific Name Search magglutination) were performed and the results were negative.
Figure 2: Trichoscopy of the alopecic patch revealed numerous yellow dots, a few black dots, fine vellus hairs, and broken hair shafts

Click here to view
Figure 3: (a) Histopathology showed mixed inflammatory cell infiltrate in the deep dermis (H and E; vertical section; ×10). (b) Histopathology showed mixed inflammatory cell infiltrate, including a combination of neutrophils, lymphocytes, and numerous plasma cells.(H and E, ×40)

Click here to view



   Discussion Top


In 1992, Iwata et al. described in Japan a new entity characterized by the presence of a solitary alopecic nodule that showed a pseudocystic cavity in the histopathology.[1] At that time, they named this new entity “pseudocysts of the scalp (PCS);” but later on, in 2009, the term alopecic and aseptic nodules of the scalp (AANS) was coined by Abdennader and Reygagne, as they did not find the pseudocysts in all cases, while they noticed that all the nodules are alopecic with a sterile punctured material.[1],[2],[3],[4],[5] Currently, some authors consider PCS and AANS to be the same entity, while Lee et al. believed them to be two different entities.[2],[5],[6] Overall, the prognosis of the condition is good, and it can even resolve spontaneously.[7],[8] Based on previous studies, chronic cases are rarely reported, and the mean disease duration ranged from 6.4 to 27 months.[4],[7],[8],[9] Here, we report on a 27-year-old Iraqi man with clinical, trichoscopic, and histopathologic features consistent with AANS. However, the course of the disease differs from the previously reported cases, insofar as it lasted for more than 6 years, with periods of remission that varying from 3 weeks to 2 months. Furthermore, after a close observation of the recurrent episodes, three clinical stages of the scalp lesion could be identified:

  • Stage I: firm, tender nodule lasting 1–3 weeks, which may be associated with tenderness and cervical lymphadenopathy. Puncture is usually negative or hemorrhagic, but sterile
  • Stage II: alopecic fluctuating nodule. The nodule becomes less tender, fluctuating, and accompanied by alopecia on the surface. Puncture usually results in a sterile, citrine-yellowish material. This stage often lasts 3–7 days
  • Stage III: alopecic patch. The fluctuating nodule is flattened spontaneously or after puncture, leaving an area of alopecia surrounded by the normal scalp. This stage lasts for 2–3 months until hair regrowth occurs. At this stage, the condition may be misdiagnosed as alopecia areata.


It is important to know the different stages of the disease as this may be helpful in differentiation of AANS from other diseases, such as alopecia areata, dissecting cellulitis of the scalp, bacterial folliculitis, ruptured trichilemmal cysts, and folliculitis decalvans, which are the main differential diagnoses of this condition.[7],[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Iwata T, Hashimoto T, Niimura M. A pseudocyst with inflammatory granulation tissue on scalp – Pseudocyst of scalp. Jpn J Clin Dermatol 1992;46:9-16.  Back to cited text no. 1
    
2.
Abdennader S, Reygagne P. Alopecic and aseptic nodules of the scalp. Dermatology 2009;218:86.  Back to cited text no. 2
    
3.
Lázaro-Simó AI, Sancho MI, Quintana-Codina M, Viladomiu EDA, Millet PU, Redonnet MS. Alopecic and aseptic nodules of the scalp with trichoscopic and ultrasonographic findings. Indian J Dermatol 2017;62:515-8.  Back to cited text no. 3
    
4.
Abdennader S, Vignon-Pennamen MD, Hatchuel J, Reygagne P. Alopecic and aseptic nodules of the scalp (pseudocyst of the scalp): A prospective clinicopathological study of 15 cases. Dermatology 2011;222:31-5.  Back to cited text no. 4
    
5.
Grimalt R. Alopecic and aseptic nodules of the scalp and pseudocyst of the scalp: 2 different conditions or one single entity? J Cosmetol Trichol 2016;1:105-2.  Back to cited text no. 5
    
6.
Lee SS, Kim SY, Im M, Lee Y, Seo YJ, Lee JH. Pseudocyst of the scalp. Ann Dermatol 2011;23:S267-9.  Back to cited text no. 6
    
7.
Seol JE, Park IH, Kim DH, Park SH, Kang JN, Kim H, et al. Alopecic and aseptic nodules of the scalp/pseudocyst of the scalp: Clinicopathological and therapeutic analyses in 11 Korean patients. Dermatology 2016;232:165-70.  Back to cited text no. 7
    
8.
Rodríguez-Lobato E, Morgado-Carrasco D, Giavedoni P, Ferrando J. Alopecic and aseptic nodule of the scalp in a girl. Pediatr Dermatol 2017;34:697-700.  Back to cited text no. 8
    
9.
Eisenberg EL. Alopecia-associated pseudocyst of the scalp. J Am Acad Dermatol 2012;67:e114-6.  Back to cited text no. 9
    
10.
Gupta I, Dayal S, Kataria SP. Aseptic and alopecic nodules of scalp: A rare and underdiagnosed entity. Int J Trichol 2018;10:231-3.  Back to cited text no. 10
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed597    
    Printed18    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal