Zúñiga REY, Ojeda MAL, Guerrero HDV, Alcántara RVD, Arce MGR, Gutiérrez ÁSA, Moreno LLM

Language: Spanish
References: 13
Page: 215-221
PDF size: 443.64 Kb.

ABSTRACT

We report a 65-year-old male with a history of wellcontrolled type 2 diabetes presenting with a two-year history of a scalp dermatosis involving the prefrontal, vertex, parietal, and occipital regions. The eruption was characterized by multiple circular pseudoalopecic patches with heterogeneous pigmentation, comedones, and areas of atrophy, associated with intermittent pruritus. Dermoscopy revealed dilated follicular openings, brown spots, a whitish perifollicular halo, comedones, and a predominance of single follicular units—findings suggestive of active inflammation with incipient follicular damage. Laboratory evaluations, including acute-phase reactants and an extended immunological profile, were within normal limits. Histopathological examination demonstrated lamellar hyperkeratosis, mild epidermal atrophy, vacuolar degeneration of the basement membrane, follicular dilatation with keratin plugs, and a perifollicular lymphocytic infiltrate, confirming a diagnosis of comedonal lupus of the scalp. Management was initiated with a tapering regimen of high-potency topical corticosteroids, hydroxychloroquine (200 mg/day), and strict photoprotection. Significant clinical improvement was observed at the twomonth follow-up; at six months, the patient remained stable with no evidence of systemic involvement. Comedonal lupus is a rare variant that can mimic acneiform eruptions. Early recognition and meticulous clinicopathological correlation are essential to prevent progression to irreversible scarring alopecia.

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