Tumid Lupus Erythematosus Presenting as Patchy Alopecia: A Discussion of Alopecia Associated With Lupus Erythematosus

The document discusses a case of Tumid Lupus Erythematosus (TLE), a subtype of chronic cutaneous lupus erythematosus, presenting as patchy alopecia. The 39-year-old male patient initially diagnosed with alopecia areata showed improvement with intralesional triamcinolone treatment but returned with recurring alopecia. A biopsy revealed a superficial and deep dermal perivascular and periadnexal lymphocytic infiltrate, leading to a diagnosis of TLE. The patient was treated with topical tacrolimus, oral hydroxychloroquine, and continued intralesional triamcinolone injections, resulting in hair regrowth. The document emphasizes the importance of considering TLE in the differential diagnosis for non-cicatricial alopecia, especially in patients resistant to first-line treatments for common causes of hair loss. It also highlights the need for an algorithmic approach to diagnosing alopecia, including a thorough physical examination, trichoscopic evaluation, and biopsy when necessary.