Jiminez Victoria S, Workman Eleanor, Jalali Omid
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA.
Dermatology, Baylor College of Medicine, Houston, USA.
Cureus. 2024 Nov 14;16(11):e73699. doi: 10.7759/cureus.73699. eCollection 2024 Nov.
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.
脂肪性头皮（LS）和脂肪性脱发（LA）是罕见的疾病，涉及头皮皮下脂肪组织的局灶性或弥漫性增生。关于这些疾病的病因知之甚少，在治疗策略上也没有共识。总体而言，这种情况是良性的，通常为孤立性。然而，有报道称在存在另一种涉及头皮和头发的致病过程时会并发头皮水肿。作者报告了一例中年女性的严重头皮水肿病例，该患者双侧额部头皮患有四年的扁平苔藓性毛囊病（LPP）。患者额部头皮弥漫性变薄，伴有毛囊周鳞屑，进一步检查发现头皮其余部分有明显水肿和质地变软。对额部头皮进行了钻孔活检，结果与LPP一致。LA通常见于头皮增厚和脱发同时存在的区域，组织学上炎症很少或没有。该病例突出了炎症性瘢痕性脱发患者中存在头皮水肿的情况，此前尚未有过报道。这可能提示在存在另一种原发性激发性疾病（如瘢痕性脱发）时，这种头皮增生性或水肿性疾病谱出现了一种新的变异，作为一种反应性过程。此外，在排除可治疗的脱发疾病（如LPP）后，LA应作为一种排除性诊断。
