Sarcoidal alopecia as a mimic of discoid lupus erythematosus

Scalp sarcoidosis with systemic involvement

“…1,2 Our case is unusual because the patient had been suffering from hair loss for more than 10 years before the systemic disease and the cicatricial alopecia involved most of the scalp with a clinical picture that closely resembled lichen planopilaris.…”

“…[1][2][3][4][5] On the other hand, permanent alopecia caused by sarcoidosis is rare and is usually characterized by a few patches of cicatricial alopecia resembling discoid lupus erythematosus. 1 We report a case of extensive cicatricial alopecia with systemic involvement caused by sarcoidosis in a 45-year-old Italian female.…”

Skin manifestations of sarcoidosis

“…Other less common specific lesions of sarcoidosis are lupus discoid-like lesions [99,100], lesions resembling lichen sclerosus [101], follicular lesions [102], pseudotumoural sarcoidosis and lesions resembling breast carcinoma [103], palmar erythema [104], itchy granulomatous eruption [105], photoinduced lesions of sarcoidosis [106], lipodermatosclerosis-like lesions [107], and cellulitis-like lesions [108]. Finally, the development of oedema in the lower extremities, generally one-sided, can also be a rare specific manifestation of sarcoidosis [109].…”

“…Scalp alopecia is rarely reported in sarcoidosis [100,[115][116][117][118]. Sarcoidal alopecia predominantly affects African-American women.…”

What is your diagnosis?

“…Scalp sarcoidosis has been reported as a rare cause of both localized and diffuse alopecia 2 . It may start as an atrophic, red, and scaling area of alopecia, which must be distinguished histologically from chronic discoid lupus erythematosus of the scalp, lichen planopilaris, Brocq alopecia, folliculitis decalvans, dissecting cellulitis of the scalp and necrobiosis lipoidica [3][4][5][6] . Scalp biopsy is required for the diagnosis of scalp sarcoidosis.…”