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 Table of Contents  
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 144-145  

Linear alopecia areata

1 Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication24-Aug-2016

Correspondence Address:
Shricharith Shetty
Department of Dermatology, OPD No. 21, Kasturba Medical College and Hospital, Manipal - 576 104, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-7753.189017

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Alopecia areata (AA) over scalp is known to present in various shapes and extents of hair loss. Typically it presents as circumscribed patches of alopecia with underlying skin remaining normal. We describe a rare variant of AA presenting in linear band-like form. Only four cases of linear alopecia have been reported in medical literature till today, all four being diagnosed as lupus erythematosus profundus.

Keywords: Alopecia, alopecia areata, linear alopecia

How to cite this article:
Shetty S, Rao R, Kudva R R, Subramanian K. Linear alopecia areata. Int J Trichol 2016;8:144-5

How to cite this URL:
Shetty S, Rao R, Kudva R R, Subramanian K. Linear alopecia areata. Int J Trichol [serial online] 2016 [cited 2023 Feb 8];8:144-5. Available from: https://www.ijtrichology.com/text.asp?2016/8/3/144/189017

   Introduction Top

Alopecia areata (AA) is a common, usually, nonscarring type of hair loss affecting 0.1-0.2% of the general population. [1] Typically, it presents as circumscribed patches of alopecia; the skin of the affected area remain normal and smooth. Here, we report an unusual case of AA showing a linear band-like form of alopecia traversing over the center of the scalp.

   Case Report Top

A 35-year-old male patient presented with a linear bald patch on the scalp which was persisting for the past 3 years. Hair loss was initially noted in the vertex area of the scalp which then gradually progressed in a linear pattern toward the temporal region on either side in the period of 2 weeks. There was no associated itching or swelling in the alopecic area. At around 2 cm in front of the helix of pinna, a linear patch of alopecia measuring 22 cm long and 2 cm wide was seen, traversing the center of the scalp [Figure 1]. The underlying skin was smooth and normal in color without any evidence of scaling, atrophy, or induration. Nails were normal. The hair pull test and the perilesional trichogram did not yield any abnormalities. A trichoscopic evaluation revealed short vellus hair in center and hairs with the tapering base at the periphery. Histopathological examination revealed lymphocytic infiltrate in peribulbar area [Figure 2]a with an increase in telogen hair units along with the formation of a fibrous stellae [Figure 2]b. Special staining with alcian blue showed negative staining for mucin. A diagnosis of AA was considered and he was treated with monthly intralesional triamcinolone acetonide (5 mg/ml) injections along with topical minoxidil 5% solution.
Figure 1: (a and b) Linear band of alopecia traversing center of scalp

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Figure 2: Histopathology (H and E, ×100) (a) peribulbar lymphoid infiltrate (b) follicular stellae and telogen unit hairs

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   Discussion Top

AA over scalp is known to present in various shapes and extents of hair loss. AA has been classified into different types based on the pattern (e.g., alopecia reticularis, ophiasis, and sisiapho type) and extent of alopecia (e.g., AA circumscripta, AA totalis, and AA universalis). However, AA presenting in linear band-like form traversing center of the scalp is very rare. Four cases of histologically proven, lupus erythematosus profundus (LEP) presenting with linear alopecias have been reported in medical literature. [2],[3],[4] Three of these cases simulated AA clinically only to be proven otherwise by histopathology. Histopathologically, a peribulbar lymphocytic infiltrate, a so-called "swarm of bees," is considered as the diagnostic histopathologic feature of AA in early active stage and it may be subtle or even absent in the chronic stage of AA. Increased hairs in the catagen or telogen phase, follicular miniaturization, and pigmentary incontinence around the hair follicles are also frequently found in AA, and the former two findings are more significant in long-standing lesions of AA. [5] LEP demonstrates lobular lymphohistiocytic infiltrate often with plasma cells in adipose tissue. In well-established lesions hyalinization of adipose lobules with stromal mucin deposition is prominent. [6] In the present case, scant peribulbar infiltrate, increase in catagen hair and pigmentary incontinence around hair follicle are consistent with features of a long-standing case of AA and absence of mucin deposition along with normal adipose tissue rules out LEP. In terms of linear lesions in dermatology, quite a few dermatoses can occur over the scalp such as linear scleroderma, linear lichen planus, linear psoriasis, and linear epidermal nevus. [7] All of these dermatoses show visible cutaneous changes and often they may extend to the adjoining smooth skin over the hairlines or they may involve other parts of the body simultaneously. It is difficult to explain the reason why AA occurred in a linear pattern here. AA is known for its unpredictability, and this is probably the first report in the medical literature describing the linear band-like form of AA.

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   References Top

McDonagh AJ, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol 2002;27:405-9.  Back to cited text no. 1
Nagai Y, Ishikawa O, Hattori T, Ogawa T. Linear lupus erythematosus profundus on the scalp following the lines of Blaschko. Eur J Dermatol 2003;13:294-6.  Back to cited text no. 2
Shin MK, Cho TH, Lew BL, Sim WY. A case of linear lupus erythematosus profundus on the scalp presenting as alopecia. Korean J Dermatol 2007;45:1280-3.  Back to cited text no. 3
Rhee CH, Kim SM, Kim MH, Cinn YW, Ihm CW. Two cases of linear alopecia on the occipital scalp. Ann Dermatol 2009;21:159-63.  Back to cited text no. 4
Yoon TY, Lee DY, Kim YJ, Lee JY, Kim MK. Diagnostic usefulness of a peribulbar eosinophilic infiltrate in alopecia areata. JAMA Dermatol 2014;150:952-6.  Back to cited text no. 5
Winfield H, Jaworsky C. Connective tissue diseases. In: Elder DE, Elenitsas R, Murphy GF, Johnson BL, Xu X, editors. Lever's Histopathology of the Skin. 10 th ed. New Delhi: Wolters Kluwer (South Asian edition); 2010. p. 279-310.  Back to cited text no. 6
Tagra S, Talwar AK, Walia RL. Lines of Blaschko. Indian J Dermatol Venereol Leprol 2005;71:57-9.  Back to cited text no. 7
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  [Figure 1], [Figure 2]

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