Granulomatous Alopecia Areata
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Studysummary In this report, a 46-year-old woman's sudden diffuse hair loss was diagnosed as granulomatous alopecia areata, with spontaneous hair regrowth observed after two months. This case highlights that granulomatous inflammation should not exclude the diagnosis of alopecia areata, emphasizing the importance of clinicopathological correlation.
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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.
