The patient is a 40 yo woman with an eight year history of scarring alopecia.
Her ANA is + at 1:160 - all other labs are normal.
No other cutaneous findings or systemic disease other than "fibromyualgia."
She has been treated with 200 mg of plaquenil b.i.d. for a number of years. This has not been of much help.
The patient is quite concerned about her scalp. She's going through a divorce and worries about her appearance.
Questions?
1) Any value to a biopsy?
2) Would scalp reduction be an option?
3) Role for hari transplantation? Should a biopsy be done first
In view of positive ANA 1:160 ( ?pattern) and presence of scarring alopecia, chronic discoid lupus erythematous would be most likely diagnosis.
ReplyDeleteShe may have positive anti Ro and La too so it's worthwhile checking them.
Because the alopecia appeared scarred, chances of hair regrowth is very slim. I am not sure if biopsy will help but if done together with IF studies this would be able to confirm clinical diagnosis.
I would continue to advise her to avoid excessive sun exposure but continue with her sunblock and a hat if she goes out under hot sun.
Plaquenil 200mg bd would help to keep disease under control. Intra lesional traimcinolone injection to the affected alopecic areas may help to salvage the inflammatory parts.
Henry Foong FRCP