G136 An Unusual Case of Alopecia in a Toddler

May 2019

GM O’Sullivan, V. S. Shivamurthy, Kristina Semkova, Jemima E. Mellerio

alopecia non-scarring alopecia anti-fungal cream topical steroids perifollicular infiltrate lupus profundus lupus erythematosus oral steroids hydroxychloroquine antimalarials systemic steroids discoid lupus erythematosus systemic lupus erythematosus hair loss Plaquenil DLE SLE

TLDR A 2-year-old boy with a rare type of lupus causing hair loss improved with oral steroids.

A 2-year-old Caucasian boy presented with an annular plaque on his forehead and anterior scalp, leading to non-scarring alopecia. Despite treatment with anti-fungal cream, shampoo, and topical steroids, there was no improvement. Mycology tests were negative, and skin biopsies revealed a dense perifollicular infiltrate, suggesting lupus profundus. Blood tests were normal, and there was no evidence of systemic autoimmune or inflammatory conditions. The boy responded well to oral steroids, with hair regrowth and resolution of erythema, though residual subcutaneous atrophy remained. He was started on hydroxychloroquine and monitored. Lupus profundus is rare in children, often affecting the face, and can be treated with antimalarials, systemic steroids, dapsone, or methotrexate.

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