CC-05   SARCOIDOSIS OF THE SCALP

RM Ngwanya. University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.

Sarcoidosis is a multi-system disease of unknown aetiology. It is a diagnosis of exclusion. It affects most commonly the skin, lungs, lymph nodes, eyes, bones, spleen and liver. Between 10% - 25% of patients with systemic sarcoidosis have skin involvement (1). The involvement of scalp in sarcoidosis is rare. There have only been twenty-eight (28) reported cases in the English language literature of scalp sarcoidosis. (2) It affects mostly African-American women with systemic sarcoidosis. The clinical features on the scalp vary from patchy alopecia, discoid lupus like, both scarring and non-scarring alopecia, patchy erythema with scales and nodules. The predominant clinical feature is that of scarring alopecia. The histopathological diagnosis is established by demonstrating the sarcoidal granulomas. These are discrete, round to oval, and composed of epithelioid histiocytes and multinucleate giant cells, which may be of either Langhans or foreign body type. These are surrounded by a sparse rim of lymphocytes, the so-called "naked" appearance. The stains for organisms should be negative and foreign body should be excluded. Two cases of sarcoidosis of the scalp are presented. CASE 1 -20- Age Sex Race Clinical feature (scalp) Other Body Sites System 45 Female African Annular Plaque Face Lung and lymph Scarring nodes Age Sex Race Clinical feature (scalp) Other Body Sites System 62 Female African Indurated nodules Face Lymph nodes Annular plaque Body Scarring alopecia Lower legs CASE 2 Conclusion: Sarcoidosis of the scalp, rare as it is, is an important cause of scarring alopecia (3). When present it should serve as a marker for Cutaneous Sarcoidosis and systemic involvement.

References:

1. English JCIII, Patel P.J., Greer K.E. Sarcoidosis. JAAD 2001; 44: 725-743.

2. Pajani Katta, Bruce Nelson, Diana Chen, and Henry Roenigic. Sarcoidosis of the Scalp: A case series and review of the literature. JAAD 2000; 42: 690-2

3. Maj D K M. Elston, MC, Beigfeld WF. On Cicatricial Alopecia (and other causes of permanent Alopecia) in Elisa A. Olsen, Disorders of Hair Growth Diagnosis and treatment. 1994 Page 255-314