Lupus Panniculitis of the Scalp Presenting as a Patchy Nonscarring Alopecia: Report of an Uncommon Case

Diagnosing a case of patchy alopecia in the setting of lupus erythematosus (LE) can be clinically challenging. Of the various causes of LE-specific alopecias, lupus panniculitis of the scalp is rarely reported. A 40-year-old woman presented with a nonscarring patch of alopecia over the scalp. Trichoscopy showed multiple follicular plugging, multiple thin and dystrophic hair shafts, empty follicles, and regularly distributed pinpoint white dots within the lesion. The clinical diagnoses of alopecia areata or early discoid LE were considered. However, the histopathological examination of the scalp biopsy showed typical hyaline-type fat necrosis of the subcutis along with moderate perivascular and perifollicular inflammatory infiltrate without any interface dermatitis. On direct immunofluorescence, staining for IgG, IgA, IgM, and C3 was negative. A diagnosis of lupus panniculitis of the scalp, presenting as patchy nonscarring alopecia, was rendered. Treatment with oral prednisolone and methotrexate led to complete recovery of alopecia. In conclusion, we report a rare case of lupus panniculitis of the scalp and discuss its differential diagnosis in the setting of LE.