Scalp Bogginess in the Presence of Lichen Planopilaris: Isolated Occurrence or Reactionary Process?

Lipedematous scalp (LS) and lipedematous alopecia (LA) are rare conditions involving focal or diffuse hyperplasia within subcutaneous adipose tissue of the scalp. Little is known regarding the etiology of these conditions, and there is no consensus on management strategies. Overall, the condition is benign and often isolated. However, there have been reported cases of co-existing scalp edema in the presence of another pathogenic process involving the scalp and hair. The authors present a case of significant scalp edema in a middle-aged female who presented with lichen planopilaris (LPP) of the bifrontal scalp of four years duration. The patient had diffuse thinning of the frontal scalp with a perifollicular scale, and further examination revealed significant edema and bogginess of the remainder of the scalp. A punch biopsy of the frontal scalp was obtained and consistent with LPP. LA is typically seen in areas where both scalp thickening and hair loss are present and has little or no histologic inflammation. This case highlights the presence of scalp edema in a patient with inflammatory scarring hair loss, which has not been previously reported. This may suggest a new variant of this spectrum of hyperplastic or edematous conditions of the scalp as a reactive process in the presence of another primary, inciting condition such as scarring alopecia. Additionally, LA should be a diagnosis of exclusion after ruling out treatable alopecic conditions such as LPP.