Alopecia Associated With Syringomas

In 1985, a case report was presented of a 58-year-old healthy black woman who experienced a generalized, progressive loss of scalp hair over 5 years without any significant skin eruption or hair loss elsewhere on her body. Physical examination revealed diffuse thinning of her scalp hair with no scalp scarring or eruptions, and a loss of visible hair follicles. Laboratory tests were normal. Microscopic examination of scalp biopsy specimens showed a reduction in the number of hair follicles and dilated eccrine ducts with "tadpole" tails, but no excessive fibroblastic proliferation in the dermis. No syringomas were found in a biopsy of normal hair-bearing skin from the forearm. Despite treatment with topical corticosteroids, there was no clinical improvement. This case, along with only three prior reports, suggested a possible association between alopecia and occult scalp tumors such as syringomas or eccrine duct hamartomas. However, due to the rarity of such cases, it was premature to establish a causal relationship. The authors suggested that the tumors might cause hair loss through pressure necrosis of the follicles or by creating an environment unfavorable to hair growth. They emphasized the importance of scalp biopsies in patients with unexplained hair loss even in the absence of visible cutaneous abnormalities.