Successful Treatment of a Scalp Arteriovenous Malformation With Ulcerative Hemorrhage and Localized Alopecia

Scalp arteriovenous malformation (AVM) and its clinical course associated with ulcerative hemorrhage and local alopecia are rarely reported. An 18-year-old male presented to a vascular anomalies center with scalp AVM and ulcerative hemorrhages over a 6-month period due to post-excision recurrence, initially associated with thinning hair and scalp erythema around the AVM lesion. After meticulous debridement, the patient was immediately given an ethanol embolization. He was advised against home wound care to prevent possible hemorrhage. After several effective interventional sessions over an 18-month period, not only was the AVM lesion extensively eliminated, but restoration of hair growth around the lesion was observed. This phenomenon may be attributed to the alleviation of deep, high-flow AVM steal phenomenon, which in turn restored normal blood supply to superficial layers, promoting ulcer healing and hair regrowth. This report suggests that scalp AVMs can be accompanied by AVM-related alopecia, which may recover after ethanol embolization. This report also suggests that restrictive debridement during multiple intervention sessions can be feasible in ulcerated AVMs with a high risk of hemorrhage.