P#17   Alopecia areata with a lichenoid inflammation pattern

Tobias W. Fischer, Irina Kelm, Peter Elsner. Dept of Dermatology, Friedrich-Schiller-University Jena, Germany

We present a case of a 37-year old woman who suffered from patchy hairloss for 2 years. The hairloss relapsed several times. She was treated with internal and external steroids. When we saw the patient for the first time she showed a large, circumscribed and round area of short hair in the vertex region without redness or scaling of the scalp skin. The pull test was negative. Laboratory findings showed a CRP with 6,8 mg/l, normal blood count and thyroideal parameters. The trichogram in the affected area revealed a telogen rate in a normal range (12%) and in the non affected area an increased telogen rate (27%). Histopathologically there was a normal epidermis with an anagen follicle and a lichenoid inflammation pattern with lymphocytes and plasma cells in the middle dermis. We treated the patient with oral prednisolone pulse therapy starting with 80 mg over 4 weeks in decreasing doses and Ell Cranell Dexa as a topical solution. The hairloss was stopped and hair regrowth was noted. The histological changes supposed a lichen follicularis, but clinically there was no inflammation detectable. This lead us finally to the diagnosis of alopecia areata with a lichenoid inflammation pattern. With regard to the histopathological changes we provided an anti-inflammatory treatment with steroids which may be discussed as a therapeutical option in alopecia areata. But the high dose steroid therapy interruped further hairloss and hair regrowth was noticed.