What caused hair loss and a pruritic scalp?

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.


A Photo Quiz to Hone Dermatologic Skills

Case 1:
For several months, a 70-year-old man has experienced patchy hair loss and mild itching on the top of his scalp. Over-the-counter shampoos containing tar or zinc have not been effective. The hair loss has revealed the unusual pattern of his scalp skin. The only medication the patient takes is a statin.

What is the likely cause of the hair loss and pruritus?

A. Syphilis.
B. Lichen planopilaris.
C. Cutaneous lupus erythematosus.
D. Normal male pattern hair loss.
E. Drug-induced hair loss.

Bonus question: Can you identify the scalp skin pattern?

(Answer on next page)


Case 1: Cutaneous lupus erythematosus

Patchy hair loss is not characteristic of male pattern baldness, nor is it typical of a drug-induced reaction—which usually features a diffuse pattern. This patient had cutaneous lupus erythematosus, C; the diag-nosis was confirmed by a biopsy that ruled out lichen planopilaris. Rapid plasma reagin testing excluded syphilis.

This patient received antimalarial therapy, which halted the loss of hair; however, scalp scarring from the initial cicatricial hair loss remained. Minimal, if any, hair regrowth can be expected.

Answer to the bonus question:
The thick folds in the patient’s scalp skin are characteristic of cutis verticis gyrata, which is not related to lupus and has no clinical significance.  ■