Aching alopecia

Abstract

A 70-year-old woman suffered from scalp tenderness, progressive hair loss and diffuse shoulder pain. She was misdiagnosed for months, her symptoms being attributed to ageing. When we examined her, we found two striking bilateral patches of alopecia in the temporal regions. Her erythrocyte sedimentation rate was elevated. We biopsied the temporal artery and found typical signs of giant cell arteritis. The lumen of the artery was narrowed with an inflammatory infiltrate of all the vessel layers containing giant cells (figure A). We started prednisone and her pain improved. Nevertheless, local hair loss continued and scalp necrosis occurred one month later (figure B). Slow healing was obtained by simple wound dressings.Several common conditions such as androgenic alopecia, telogen effluvium, and zoster cause scalp tenderness (trichodynia). However, in our patient, a progressive painful bitemporal hair loss was the manifestation of giant cell arteritis. A 70-year-old woman suffered from scalp tenderness, progressive hair loss and diffuse shoulder pain. She was misdiagnosed for months, her symptoms being attributed to ageing. When we examined her, we found two striking bilateral patches of alopecia in the temporal regions. Her erythrocyte sedimentation rate was elevated. We biopsied the temporal artery and found typical signs of giant cell arteritis. The lumen of the artery was narrowed with an inflammatory infiltrate of all the vessel layers containing giant cells (figure A). We started prednisone and her pain improved. Nevertheless, local hair loss continued and scalp necrosis occurred one month later (figure B). Slow healing was obtained by simple wound dressings. Several common conditions such as androgenic alopecia, telogen effluvium, and zoster cause scalp tenderness (trichodynia). However, in our patient, a progressive painful bitemporal hair loss was the manifestation of giant cell arteritis.