Objective: To compare the dermoscopic features with the clinical appearance and histologic findings of a case of inflammatory scarring alopecia presenting in a 35 year old Caucasian female being treated with a tumor necrosis factor blocker for inflammatory bowel disease.
Results: The patient presented with a 3 week history of patches of asymptomatic pink, scaly plaques on her trunk, palms and legs along with rapid onset of hair loss with associated scalp pruritus. Scalp exam revealed 2-6 cm plaques of alopecia with loss of follicular orifices, perifollicar erythema and scale as well as polytrichia. The clinical exam was suggestive of Lichen Planopilaris. Dermoscopic scalp exam highlighted the loss of follicular orifices, scalp erythema and micaceous scale. The dermoscopic exam suggested a diagnosis of Psoriasis. A punch biopsy taken from the edge of one of the inflammatory plaques confirmed a diagnosis of Psoriasis. Biopsies of plaques on the trunk and hand were also consistent with Psoriasis.
Conclusions: TNF blocker induced psoriasis has recently been reported in the literature. Psoriasis presenting as cicatricial or scarring alopecia has also been rarely reported. Our case did not demonstrate the twisted red loops previously reported as a dermoscopic pattern of psoriasis. The micaceous nature of the scale apparent on dermoscopy was helpful in suggesting the diagnosis of Psoriasis. This case highlights scarring alopecia as an important emerging side effect of TNF blockers and the utility of clinical-pathological-dermoscopic correlation in making the diagnosis. In consultation with the patient’s gastroenterologist, the patient’s TNF blocker was discontinued and her psoriasis is being managed with super-potent topical steroids.