Granulomatous Alopecia Areata
TLDR A woman's rare hair loss condition improved on its own, suggesting this type might recover like common cases.
A 46-year-old woman with a history of Graves disease experienced sudden, accelerated hair loss and was provisionally diagnosed with diffuse alopecia areata (AA) based on trichoscopy findings. Despite slight deficiencies in iron, folate, and vitamin D, which were treated, her thyroid function and other lab tests were normal. A scalp biopsy revealed granulomatous inflammation, a rare finding in AA, but no signs of sarcoidosis or syphilis were present. Initially planned to be treated with diphencyprone, her hair spontaneously regrew after 2 months. This case, the first reported in the UK and only the second internationally to show spontaneous resolution, suggests that granulomatous AA may have a prognosis similar to typical AA. The case highlights the importance of correlating clinical presentation with histopathology, as granulomatous inflammation does not rule out AA, and the histopathology of alopecia can be misleading.
