The immunologic profiles including antinuclear antibody anti

The immunologic profiles, including antinuclear antibody, anti-extracted nuclear antigen (ENA) antibody, C3, and C4 were all within normal ranges. However, plain chest films and computed tomography (CT) scans revealed pulmonary sarcoidosis with lymphadenopathy (Figure 3). Lung function tests showed normal spirometric values and diffusing capacity. Ophthalmologic examination ruled out any ocular involvement. The results of other blood tests, such as complete blood cell counts, and measurement of serum aspartate aminotransferase, alanine aminotransferase, creatinine, blood urea nitrogen, sodium, potassium and calcium levels, were all within normal limits. Because the patient had significant overall improvement and regrowth of hair, we discontinued local corticosteroid treatment in January 2012. The dosage of oral hydroxychloroquine was also tapered to 200 mg daily (beginning February 2012) and the disease showed no deterioration after 3 months (Figure 4). Serial CT examinations of the chest from 2009 to 2012 showed that p97 the disease had stabilized, and lung function tests remained normal.
Discussion Sarcoidal alopecia is a rare manifestation of cutaneous sarcoidosis that predominantly affects black women. It is a form of secondary cicatricial alopecia and can have variable morphologies. Most commonly, cutaneous sarcoidosis on the frontoparietal facial region may extend into the scalp, which may lead to hair loss. Such lesions are the type of sarcoidal alopecia that most mimics DLE clinically. On the scalp, sarcoidosis can manifest as atrophic, erythematous, scaly, or ulcerative areas of alopecia. The typical appearance of DLE is of well-circumscribed, erythematous, scaly, atrophic plaques, that may occasionally also be ulcerative. In both situations, follicular plugging can be observed on dermoscopy. The differential diagnosis of sarcoidal alopecia and DLE can be made by histopathologic examination. Sarcoidal alopecia shows classic naked granulomas in the dermis. In contrast, DLE is characterized by follicular plugging, epidermal atrophy, vacuolar degeneration of basal keratinocytes, and basement membrane thickening, as well as superficial and deep perivascular and periadnexal lymphocytic infiltrates. Patients with sarcoidal alopecia almost always have other cutaneous lesions, and the vast majority of cases will also demonstrate systemic involvement. About 30% of patients with the initial form of cutaneous sarcoidosis will develop its systemic form within months to several years of diagnosis. Therefore, it is recommended that any patient with cutaneous sarcoidosis be screened for systemic lesions, even if there are no clinical complaints of systemic involvement at initial visits. Several diagnostic studies can be performed during the workup of sarcoidosis, including chest films, chest CT scans, and pulmonary function tests. A review of the English literature revealed 47 reported cases of scalp sarcoidosis, including ours. In these studies, patients were predominantly female (35/40). Where race was mentioned, 23 of 36 patients were black and three patients were Chinese. Many of the patients (32 of 37) exhibited extracutaneous involvement, and the lung was the most frequently involved site. Other extracutaneous manifestations included lymphadenopathies (18 of 37 patients), musculoskeletal involvement (4 of 37 patients), hepatosplenomegaly (3 of 37 patients), and ocular involvement (2 of 37 patients). Our review of cases documented diverse morphologies of scalp sarcoidosis, including papules, nodules, indurative plaques, scales, and ulcers. Most of these cases showed scarring alopecia, but some cases of non-scarring alopecia have also been reported. Sarcoidal alopecia may resemble DLE, lichen planopilaris (follicular lichen planus), pseudopelade of Brocq (alopecia cicatrisata), necrobiosis lipoidica, morphea or alopecia neoplastica. DLE is the most confusing form. A comparison of the features of sarcoidal alopecia and DLE is presented in Table 1.