Borderline Tuberculoid leprosy of the scalp mimicking alopecia areata-vitiligo overlap syndrome: A case report

Abstract

The scalp is known to be a zone relatively immune to Mycobacterium leprae. Regardless, there have been multiple reports of multibacillary (MB) leprosy affecting the scalp. However, less than ten paucibacillary leprosy (PB) cases with scalp involvement are known, two of which also had patches of alopecia. Herein, we report the third case of 'leprotic alopecia' in a 26-year-old female secondary to PB leprosy. Although the clinical picture mimicked alopecia areata-vitiligo overlap syndrome, histopathological examination revealed borderline tuberculoid (BT) leprosy of the scalp.

Annular plaque over the scalp with patchy alopecia

“…Mycobacterium leprae prefers colder areas of the human body, 1 a direct implication of which is the development of “ Immune zones ” in leprosy—the scalp, axillae, genitalia, groin, eyelids, transverse band of skin overlying lumbosacral area, and the perineum. Most studies on leprosy with scalp involvement as well as mild and moderate infiltration showed no impairment of the vital part of the follicle as the deeper areas are not affected 2–4 . In our patient, however, there was a significant destruction of the hair follicles leading to patchy cicatricial alopecia.…”

“…Most studies on leprosy with scalp involvement as well as mild and moderate infiltration showed no impairment of the vital part of the follicle as the deeper areas are not affected. [2][3][4] In our patient, however, there was a significant destruction of the hair follicles leading to patchy cicatricial alopecia.…”

“…There have been less than 10 reports of paucibacillary leprosy involving the scalp, out of which three also had patchy alopecia 2–4 . Alopecia can be a presentation of leprosy and should be considered as a differential in endemic areas with such unusual presentations.…”

“…There have been less than 10 reports of paucibacillary leprosy involving the scalp, out of which three also had patchy alopecia. [2][3][4] Alopecia can be a presentation of leprosy and should be considered as a differential in endemic areas with such unusual presentations. According to the latest data issued by WHO, Brazil, India, and Indonesia have 72.5% of registered cases and 74.0% of new cases of leprosy detected in 2020.…”