Case Number : Case 3046 - 10 March 2022 Posted By: Saleem Taibjee

Surface seborrheic dermatitis-like/psoriasiform change, significant sebaceous gland atrophy, follicular miniaturization; Also expecting more catagen/telogen shift though not really seen here. Overall non-scarring alopecia favor psoriatic alopecia, DDx TNF-a inhibitor induced alopecia, correlate medication list/clinical history.

I think that it shows features of seborrhoeic dermatitis and androgenetic alopecia.

1 hour ago, Shawn said:

Surface seborrheic dermatitis-like/psoriasiform change, significant sebaceous gland atrophy, follicular miniaturization; Also expecting more catagen/telogen shift though not really seen here. Overall non-scarring alopecia favor psoriatic alopecia, DDx TNF-a inhibitor induced alopecia, correlate medication list/clinical history.

Agree, Sebaceous gland atrophy is quite suggestive of psoriatic alopecia. 

9 hours ago, Shawn said:

Surface seborrheic dermatitis-like/psoriasiform change, significant sebaceous gland atrophy, follicular miniaturization; Also expecting more catagen/telogen shift though not really seen here. Overall non-scarring alopecia favor psoriatic alopecia, DDx TNF-a inhibitor induced alopecia, correlate medication list/clinical history.

Perfect. Agree

There’s a lot of mucin in dermis..why not a spongiotic reaction pattern of lupus?

2 hours ago, vincenzo said:

There’s a lot of mucin in dermis..why not a spongiotic reaction pattern of lupus?

Non scarring lupus alopecia should have interface change, superficial and deep inflammation and no Sebaceous gland atrophy. 

Ok! Thanks Shawn. 

This recent case was shared with me by Dr Hazem Ibrahim.

I think it is a lovely example of psoriatic alopecia. As some of you have already picked up, the clues are the loss/atrophy of sebaceous glands and widespread basophilic remnants of these sebaceous glands. This is in the absence of significant inflammation or convincing scarring. There is also miniaturisation, and hence possible concomitant androgenetic alopecia. Spongiosis is not uncommon in psoriatic alopecia. Clinically this may reflect that psoriasis of the scalp and seborrhoeic dermatitis can be difficult to distinguish and may fall on a spectrum 'sebopsoriasis'.

I really learnt about this from Case 1460 on Spot diagnosis (DermpathPro) posted by Arti Bakshi on 28 January 2016. I don't think it is commonly biopsied, and I have been waiting until recently to see a case in my own practice.

BW, Saleem