Permanent Alopecia as a Manifestation of Chronic Graft-Versus-Host Disease of the Scalp: Clinical, Dermoscopic, and Histopathological Observations

    June 2018 in “ Clinical and Experimental Dermatology ”
    Flávia Machado Alves Basílio, Betina Werner, Fabiane Mulinari‐Brenner
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    TLDR Permanent hair loss after a stem cell transplant can be a sign of chronic immune system attack on the scalp.
    The document discusses a case of permanent alopecia in a 44-year-old man who had undergone allogeneic hematopoietic stem cell transplantation (HSCT) for severe aplastic anemia 23 years prior. The patient presented with diffuse hair loss and vitiligo-like lesions on the scalp. Dermoscopic and histopathological examinations confirmed chronic graft-versus-host disease (cGVHD) of the scalp. Dermoscopy revealed reduced follicular openings and perifollicular scale, while histology showed a perifollicular lichenoid pattern, similar to lichen planopilaris (LP). The study suggests that permanent alopecia after HSCT can manifest in two histological patterns: inflammatory and non-inflammatory. The authors emphasize the importance of dermoscopy and scalp biopsy in evaluating permanent alopecia post-HSCT to detect early changes, guide biopsy, and distinguish cGVHD of the scalp from other conditions like alopecia areata or permanent chemotherapy-induced alopecia.
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