Lipedematous Alopecia: An Uncommon Clinicopathologic Variant of Nonscarring but Permanent Alopecia

A 52-year-old black woman experienced gradual scalp swelling and slowed hair growth over 5 years, leading to diffuse alopecia, particularly on the vertex and parietal regions, with a peripheral crown of hair spared. Despite no history of trauma or medication use, and normal laboratory tests, a CT scan revealed thickening of subcutaneous fatty tissue on the scalp. A biopsy showed a normal epidermis and dermis but a significant increase in subcutaneous fat thickness, with hair follicles replaced by fibrous tracts and no inflammation. The condition was identified as lipedematous alopecia, a rare form of nonscarring but permanent alopecia characterized by increased subcutaneous fat and loss of hair follicles.