Lipedematous scalp : a rare dermatological entity

Abstract

A 16-year-old Caucasian girl was admitted at the request of her physician who had noticed a soft spongy texture of her scalp. The patient had no significant discomfort or ongoing symptoms and was aware of this abnormality for a long time. There was no previous trauma history. No family members showed any similar conditions. On dermatological examination, her scalp had an increased subcutaneous thickness extending from the occiput to the vertex, compared to that of a normal scalp. The skin appeared normal and hair was abundant. No signs of inflammation were found. Her general health was good. Blood analysis was considered to be within normal limits. Marked thickening of the subcutaneous fat layer on the vertex and occipital areas was noted by magnetic resonance imaging (Fig. A – sagittal T1-weighted image & Fig. B – coronal T2-weighted detail view). On fat-suppressed T1-weighted images, signal intensity of fat tissue was decreased. Brain parenchyma and ventricles appeared normal. Ultrasonographic complementary investigation with a 12-MHz linear transducer showed that the epidermis and dermis were normal but total thickness of the scalp measured 8-9 mm (Fig. C). The thickness of a scalp of a teenager is normally half as thick as our patient’s scalp. Histological study demonstrated the normality of epidermis and dermis, without evidence of inflammation or fibrosis. There was a marked hyperplasia of subcutaneous adipose tissue with mature adipocytes (Fig. D). The findings were consistent with a diagnosis of lipedematous scalp.