BH14: Linear alopecia affecting eyelashes, eyebrow and scalp

Claire Doyle,¹ Marta Costa Blasco,¹ Anastasia Therianou² and Richard Watchorn¹

¹Beaumont Hosptial, Dublin, Ireland; and ²Imperial College Healthcare Trust, London, UK

A 24-year-old woman presented with a 3-year history of localized hair loss involving a streak on her right forehead, right eyebrow and right lash line. She was healthy and took no regular medication. She had no family history of alopecia. Examination revealed nonscarring alopecia of the right anterior scalp, right medial eyebrow and right medial right lash line in a linear pattern. The skin in the affected areas appeared healthy and no perifollicular erythema or scale was observed. Dermoscopic examination revealed preserved follicular openings. There was no hair loss elsewhere and her nails appeared unremarkable. A scalp biopsy was taken from the affected area on her scalp, and histology revealed a reduction in the number of hair follicles with a distortion in the appearance of residual follicles; follicular plugging was also seen. There was mild perifollicular chronic inflammation without evidence of interface changes. The histology was reported to be in keeping with alopecia areata. The patient has received one session of intralesional triamcinolone (10 mg mL^–1). A 1 mL intralesional injection was administered to the affected areas of the scalp and eyebrow 3 months ago with no response. Alopecia areata (AA) affects 1–2% of the general population and is often associated with autoimmune conditions such as vitiligo, thyroid disease and type 1 diabetes mellitus. AA is associated with heterogeneous patterns, including a single patch of hair loss, multiple patches of hair loss, reticular, ophiasis, sisaipho, alopecia totalis and alopecia universalis. Alopecia presenting in a linear distribution is rare. There have been two case reports in the literature of linear AA of the scalp, which were both treated with intralesional steroids and topical minoxidil 5%. Linear alopecia has more frequently been associated with lupus erythematosus profundus, with eight cases reported in the literature. To the best of our knowledge, this is the first case of linear AA affecting the scalp, eyebrow and lash line in such a unilateral distribution. This may reflect the complex pathogenesis associated with AA. It is important to consider AA as a differential diagnosis for alopecia presenting in a linear distribution.