Localized Acquired Perforating Dermatosis on Scalp Presented With Acute and Diffuse Total Alopecia

This study reports two cases of acquired perforating dermatosis (APD) on the scalp, presenting with acute diffuse and total alopecia (ADTA) in two women with underlying health conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, and end-stage kidney disease. Both cases involved hyperkeratotic papules and significant hair loss, with diagnoses confirmed through trichoscopy and biopsies. Treatment with intramuscular triamcinolone and topical therapies led to significant improvement and no recurrence after 1 year. The study suggests a possible association between APD and ADTA, with perifollicular inflammation potentially triggering APD, and highlights type 2 inflammation as a common pathway.