Scalp Psoriasis Associated with Central Centrifugal Cicatricial Alopecia

The document discusses a rare case of a 50-year-old female with a multi-year history of hair loss initially thought to be due to central centrifugal cicatricial alopecia (CCCA) but later diagnosed as scalp psoriasis. Despite scalp psoriasis being a common condition, it seldom presents as severe alopecia. The patient had previously undergone treatments with intralesional steroid injections, minoxidil, and fluocinolone acetonide with only mild improvements. Upon reevaluation after a two-year absence from the clinic, she presented with hyperkeratotic plaques with erythema on the scalp and frontal hairline. A biopsy confirmed psoriasis, showing diminished terminal hair follicles and associated fibrosis. Treatment with urea plus clobetasol ointment improved the scalp psoriasis, but the alopecia could not be reversed, although further scarring and secondary alopecia were prevented. The case emphasizes the importance of considering a broader differential diagnosis in recalcitrant hair loss to provide symptomatic relief and prevent disease progression.