With fairly benign symptoms including gradually progressive alopecia and a boggy, thickened, pruritic scalp, lipedematous alopecia is perhaps underdiagnosed, says an osteopathic physician who reports perhaps the world's first case of this condition occurring in a Hispanic female.
National report - Lipedematous alopecia is perhaps an underdiagnosed entity because of its rather benign secondary symptoms, says a physician who recently presented possibly the first case of this condition in a Hispanic female.
The patient, a 54-year-old female, presented to Nanda Channaiah, D.O., now a dermatologist in private practice in Columbus, Ohio. Dr. Channaiah was a third-year resident at NSUCOM/Sun Coast Hospital in Largo, Fla., and one of the patient's treating physicians.
"Her symptoms included gradual, progressive hair loss and 'softening' of the scalp over a 25-year period. But what was more concerning to the patient was the intractable pruritus and occasional scalp tenderness," Dr. Channaiah says.
Physical findings paint picture
"Only after palpating the scalp were we able to appreciate the textural changes of diffuse bogginess and unusual thickening of the scalp.
"In addition, a relatively diffuse alopecia with accentuation in the frontal scalp was noted," she says.
Furthermore, her physical exam revealed hyperextensibility of her joints, which is one of the reported associations of lipedematous alopecia, she adds. Other reported associations of lipedematous alopecia include diabetes, renal failure and hyperextensible skin.
To further delineate the type of alopecia, physicians performed a scalp biopsy. After receiving a diagnosis of lipedematous alopecia, physicians began researching the condition's potential causes, diagnostic work-up and treatment options, Dr. Channaiah says.
A CT scan to evaluate and measure the patient's scalp thickness was ordered. Other radiological tools that one can use to assess scalp thickness include head ultrasound or MRI, she adds. Normal scalp thickness measurements have been reported to be 4 to 5 mm, Dr. Channaiah says.
"In patients with lipedematous alopecia," she notes, "scalp thickness can range from nine to 15 mm. Our patient, particularly in the vertex scalp, was noted to have a scalp thickness of 13 mm."
She continues, "In our research, we learned there were approximately 15 cases that have been reported, the majority encompassing African-American females."
Research has not yet revealed any explanation for this apparent racial predilection, notes Dr. Channaiah, who says that to her knowledge, her patient is the first Latin female to be diagnosed and reported with this entity.
Research also showed that, "The cause is unknown and no current treatment is available for reversing the condition," Dr. Channaiah says. Thus the physicians' attention shifted to symptomatic relief.
Aiming to ease symptoms
"The patient had been treated in the past with prescription-strength shampoos, oral and topical antibiotics and antihistamines," she says.
"She stated that the antihistamines were minimally effective, but that the oral antibiotics worked from time to time," she adds. "Nothing gave her a great deal of relief."
Hoping to do better, Dr. Channaiah and colleagues developed a treatment regimen consisting of a combination of cortisone foams, antihistamines and short courses of oral antibiotics when symptoms flared. This regimen provided some - but never complete - relief, she says. Additionally, she says physicians tried a brief trial of intralesional triamcinolone injections, without much success.
"At this point," Dr. Channaiah says, "our treatments have had limited benefit, and we are continually looking for new options."
Due to its relatively benign symptomatology, especially when hair loss is not involved, she says, "This condition is perhaps underdiagnosed. Since the progression is gradual, even the patient might not be aware of textural changes" in the scalp occurring over time.