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Lipedematous Scalp
Abstract
In 1935, Cornbleet1 described a 44-year-old black woman whose scalp felt as if it were underlaid with soft cotton batting. A biopsy specimen showed an unusually thick subcutaneous fat layer, but no abnormalities of the hairs were noted. The name lipedematous alopecia was first used in 1965 by Coskey et al2 in a report of two cases with shortened hairs and thickening of the scalp due to an increase in the thickness of the subcutaneous fat layer. Hyperelasticity of the skin and hyperlaxity of the joints were associated with a third case, reported by Curtis et al.3 We are not aware of any other reports in the English-language literature. We recently experienced a case with thickening of the scalp due to an increase in the thickness of the subcutaneous fat layer, which was demonstrated by computed tomography. However, in our case no hair abnormalities were observed, similar
Lipedematous scalp (LS) and lipedematous alopecia (LA) are uncommon conditions with an unclear cause. Over the past century, about 115 cases have been documented in the literature. It is unknown if these disorders are indeed so uncommon or if cases that accept the illness as a structural alteration or are asymptomatic make the disease appear more uncommon than it is. Despite the fact that the majority of cases are seen in young and middle-aged people, the cases involving congenital, elderly, and children have also been reported. In the reported cases, female gender was observed to be dominant. The most significant clinical characteristics include felty swelling of the scalp in both disorders, diffusely or locally enlarged subcutaneous tissue with a swampy, spongy feel, and varied degrees of alopecia in LA. There is still much to learn about the pathogenetic mechanisms and therapeutic approaches for LA and LS. In this article, I review the general clinical characteristics, supposed pathogenetic mechanisms, histopathologic characteristics, diagnostic procedures, and management strategies for LS and LA.
This chapter addresses principally non‐inflammatory acquired disorders of subcutaneous fat with an emphasis on acquired lipodystrophy, fat hypertrophy, subcutaneous lipomatosis and lipoedema. Acquired lipodystrophy may be associated with other medical conditions and may occur as a result of antiretroviral therapy, total body irradiation or haematopoietic stem cell transplant, or injection of medications. Some of the subcutaneous lipodermatoses may have a genetic component. Also included in the discussion are conditions such as cellulite and skin conditions related to obesity. For each of these acquired disorders, relevant pathophysiology, methods of diagnosis and management options are discussed.
The lipedematous scalp (LS) is characterized by a thickened scalp because of the increased thickness of the subcutaneous fat layer. When the soft and boggy scalp is associated with shortened hairs and hair loss, it is referred to as lipedematous alopecia (LA). We report a case of alopecia areata with LS, which may be misdiagnosed as LA. However, the histopathologic features showed a thickened subcutaneous fat layer and hair bulb inflammation. Hair regrowth was appreciable after treatment with topical steroids, minoxidil, oral compound glycyrrhizin, and vitamin D. This case report aims to show that LS and alopecia areata may coexist, and histopathologic examination is necessary for precise diagnosis.
This chapter addresses principally non‐inflammatory acquired disorders of subcutaneous fat with an emphasis on acquired lipodystrophy, fat hypertrophy, subcutaneous lipomatosis and lipoedema. While some of the entities discussed are very common, such as cellulite and obesity, most are much rarer. Panniculitis and genetic disorders of subcutaneous fat are addressed other chapters in the book.
Soft, spongy or doughy consistency of the scalp resulting from thickening of the subcutaneous layer is termed as lipedematous scalp (LS). When such soft, boggy scalp is associated with hair loss, where the scalp hair is no longer than a few centimeters, it is referred as lipedematous alopecia (LA). There have been coincidental reports of androgenetic alopecia, psoriasis, mucinosis, and discoid lupus erythematosus with LS. We report a case of LS and alopecia areata whose characteristic histopathological feature showed a “swarm of bees” appearance and thickening of subcutaneous tissue. The diagnosis of alopecia areata was further confirmed by immunohistochemistry staining of the tissue showing CD3+ T-lymphocytes around the bulb. The aim of this case report is to make readers understand that LA and LS are not different diseases and one needs to rule out other causes of alopecia in order to pick up conditions which are essentially reversible and treatable.
Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported.We present the case of a 77-year-old white women who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white women. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp.
A 62-year-old woman presented with an 11-year history of hypothyroidism and a hysterectomy performed 12 years previously. She was receiving thyroxin treatment and consulted for the appearance of asymptomatic grooves in the scalp over the past 3 years. The grooves had gradually increased in length and size. Exploration revealed multiple asymmetrically arranged grooves with raised areas in between that were especially noticeable upon palpation ( Fig. 1). The rest of the physical exploration was normal. Computerized axial tomography (CAT) exploration was performed, along with an electroencephalogram and simple X-ray examination of the skull and hands; no alterations were noted, however. Analytical studies (including hemogram, biochemistry, antinuclear antibodies, and hormones: thyrotropin (TSH), T3, free and total thyroxin, basal cortisol, follicle-stimulated hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, testosterone, prolactin) only found a high cholesterol concentration (274 mg/dL) and low level of growth hormone. The remaining parameters were either normal or negative.Figure 1. Multiple asymmetrically arranged grooves with raised areas in between that were especially noticeable upon palpationDownload figure to PowerPointLater analytical studies made by the Endocrinology Department did not show any variations in the growth hormone levels or any other hormonal variation.The histopathologic biopsy study only revealed a slight thickening of the collagen bundles, which were arranged in the form of “collagen balls,” and a diffuse colloidal iron-positive mucinous deposit infiltrating the dermis and subcutaneous cellular tissue ( Figs 2 and 3).Figure 2. Slight thickening of the collagen bundles, which were arranged in the form of “collagen balls”Download figure to PowerPointFigure 3. A diffuse colloidal iron-positive mucinous deposit infiltrating the dermis and subcutaneous cellular tissueDownload figure to PowerPoint
Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported. We present the case of a 77-year-old white woman who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white woman. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp.
Lipedematous alopecia and lipedematous scalp are two similar unusual conditions mostly affecting healthy black women.
The purpose of our study was to report three cases of this condition with emphasis on clinical and histologic findings, and to review the literature on the subject.
The study includes clinical, echographic, and histologic findings of 3 patients, complemented with a literature review.
Two cases of lipedematous alopecia and one of lipedematous scalp in 3 white women had echographic confirmation of an increased subcutaneous layer. The presence of ectatic lymphatic vessels in the two cases with hair loss was particularly emphasized.
Our findings suggest a lessened role of racial factors, but confirms the sex implications in these related conditions, and stress the potential significance of lymphangiectatic vessels in the development of alopecia in these patients.
A nine year old Maori girl was noted to have a spongy consistency to her posterior scalp. The overlying skin appeared normal, as was hair growth in that area. The abnormal findings became more extensive over the subsequent year. A computerized tomography scan showed diffuse thickening of subcutaneous tissues posteriorly on the scalp. A skin biopsy specimen showed a normal epidermis with a thick layer of mature subcutaneous fat and some disruption of the subcutaneous architecture. The clinical features and investigations were consistent with a diagnosis of lipedematous scalp, which has been described predominantly in adult women and is usually associated with alopecia. This condition has not been reported previously in the pediatric literature.
Lipedematous scalp (LS) and lipedematous alopecia (LA) are rare conditions of unknown etiology characterized by a thick and boggy scalp due to increase in the subcutaneous fat layer. Besides the changes in the texture of skin, varying degrees of hair loss are seen in patients with LA. In this report, we present two cases with LA and one case with LS in white adults. On examination, a boggy and soft swelling of the scalp was detected in all patients. In addition, the patients with LA had alopecic areas over the boggy scalp. Histopathologic examinations of skin biopsy specimens and magnetic resonance imaging of the scalp showed increased thickness of subcutaneous fat tissue in all patients. The exact etiopathogenesis of LA and LS remain unknown. These conditions may be either reactive or compansatory responses versus yet undetected stimuli, or represent a genetic tendency. Both of the these entities have been initially reported mostly in adult black females, however, we believe that LA and LS may well occur in white subjects and may be more widespread and frequently observed than previously supposed.
Lipedematous scalp is characterized by increased subcutaneous thickness of the scalp without any hair change. A 50-year-old female presented with thickening of the scalp without alopecia. She had no disorder other than hypertension. Monthly sonographic measurements without any treatment showed a resolution tendency in some areas and an increased thickness in others. We discuss the characteristics of this rare and possibly underestimated entity, including differential diagnoses.
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