Work

Alopecic Patches on the Extremities of a Young Man

Year: 2026

Type: article

Abstract: A 28-year-old man, previously healthy, presented to our dermatology clinic with a 5-month history of progressive body hair loss. The condition initially manifested as an isolated patch of hair loss on his left forearm. Gradually, he developed new areas of hair loss on both lower extremities. Physical examination revealed well-demarcated, localized patches of scarring follicular alopecia on the limbs (Figure 1). Dermoscopy of the lesion margins showed faint perifollicular erythema and scaling, some broken hairs, and absence of follicular openings (Figure 2). Scalp examination revealed stage IV androgenetic alopecia according to Hamilton-Norwood scale, without clinical or dermoscopic signs of inflammation. The eyebrows, axillary and pubic regions were unaffected. Additional laboratory examinations including treponemal and non-treponema tests, renal, hepatic, and thyroid function, as well as antinuclear antibodies, were all normal. Given the non-specific dermoscopic findings, a skin biopsy was performed (Figure 3). Punch biopsy revealed mild orthokeratosis, a mild superficial perivascular lymphocytic infiltrate, and foci of dermal fibrosis with isolated arrector pili muscles. Several hair follicles showed mild follicular plugging, mild hypergranulosis, and a mild-to-moderate perifollicular lymphocytic infiltrate with associated fibrosis. Periodic Acid-Schiff (PAS) staining was negative for fungal organisms, and direct immunofluorescence studies were negative for all immunoreactants (Figure 3). Collectively, these findings support the clinical diagnosis of LPP. In this report, we describe a case of inflammatory scarring alopecia exclusively confined to the upper and lower limbs, representing as the sole manifestation of LPP without scalp involvement. LPP is a type of lymphocytic scarring alopecia, most often manifesting as diffuse or patchy hair loss on the scalp. In the classical form, patients develop patches of scarring alopecia, predominantly on the vertex or parietal regions [1]. Extra-scalp involvement in LPP has predominantly been described in relation to its uncommon clinical variants. In Graham Little-Piccardi-Lasseuer Syndrome (GLPLS), there is a characteristic triad consisting of patchy scarring alopecia of the scalp, body lichen planus with multiple follicular papules, and non-scarring loss of axillary and pubic hair [2]. Our review of previously published reports identified only a limited number of cases with similar clinical presentations [3, 4]. Notably, involvement of body hair in classic LPP has been only rarely documented. While the literature does refer to this finding, details regarding its prevalence, clinicopathological characteristics, and whether it presents scarring or non-scarring alopecia remain unclear [3, 5]. One reported patient exhibited progressive, pruritic body hair loss with dermoscopic findings of perifollicular erythema, scaling, and broken hairs, without scalp involvement; histopathology confirmed LPP, and treatment with doxycycline 100 mg/day and topical clobetasol three times weekly led to resolution of pruritus without hair regrowth after 3 months [3]. Another patient presented with long-standing body hair rarefaction affecting the upper and lower limbs, with dermoscopic perifollicular erythema and desquamation; dermoscopy-guided biopsy revealed perifollicular lichenoid inflammation with fibrosis, confirming corporal cutaneous lichen planopilaris, and clinical observation was chosen [4]. The differential diagnosis in our patient presented with patchy body hair loss includes alopecia areata, traction alopecia, hypothyroidism, mycosis fungoides, leprosy, and secondary syphilis [3, 4]. Based on the clinical and physical examination findings of multiple well-demarcated, localized areas of scarring follicular alopecia on the upper and lower limbs, supported by dermoscopic evidence of perifollicular erythema, scaling, and absence of follicular openings, and primarily confirmed by histopathological features showing a perifollicular lichenoid inflammatory infiltrate and fibrosis, the diagnosis of LPP was confirmed [4, 6]. Our patient was treated with topical clobetasol propionate 0.05% applied once daily to the affected areas and was scheduled for follow-up after 2 months to assess clinical response and disease progression. In summary, we report a rare presentation of LPP manifesting solely as patchy alopecia of the limbs. This case highlights the importance of thorough evaluation of LPP beyond the scalp, to guide both therapeutic decisions and future research. Hamad El Hajj: writing, drafting, editing, methodology, diagnosis, and management. Dima Jeha: writing, drafting, editing. Samer Ghosn: drafting, editing, and supervision. Hala Abi Rached Megarbane: investigation, validation, supervision, writing – review and editing. The authors received no specific funding for this work. The patient in this manuscript has given written informed consent for participation in the study and the use of his de-identified, anonymized, aggregated data and his case details (including photographs) for publication. Ethical Approval: not applicable. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Source: JEADV Clinical Practice

DOI: 10.1002/jvc2.70303

Authors: Hamad El Hajj, Dima Jeha, Samer Ghosn, Hala Abi Rached Megarbane

Institutions: Saint George Hospital, Saint Joseph University, Hôtel-Dieu de France

Language: English

Topic: Hair Growth and Disorders

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,310