Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2014:80:3;270-272
doi: 10.4103/0378-6323.132266
PMID: 24823416

Lipedematous scalp

CV Dincy Peter1 , Anne Jennifer2 , Tanumay Raychaudhury1 , Laxmisha Chandrashekhar1 , Sophia Merilyn2 , Sadashiv Gowda3 , Gowda Shyam3
1 Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
C V Dincy Peter
Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, India, Tamil Nadu
India
How to cite this article:
Dincy Peter C V, Jennifer A, Raychaudhury T, Chandrashekhar L, Merilyn S, Gowda S, Shyam G. Lipedematous scalp. Indian J Dermatol Venereol Leprol 2014;80:270-272
Copyright: (C)2014 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Lipedematous scalp is a rare clinico-pathologic entity characterized by an abnormal diffuse thickening of the subcutaneous tissue. There are fewer than 50 previous reports of the condition.

Patient 1: A 57-year-old lady presented with itching and swelling over the scalp for 2 years. She had a shaven, diffusely thickened scalp thrown into involutions [Figure - 1]a with prominences over the left parietal, vertex and occipital areas of scalp. There were no areas of alopecia, scaling or erythema on the scalp. The scalp had a boggy and spongy consistency. X-ray skull (lateral view) showed diffuse thickening over the entire scalp, with prominences over the frontal (12.3 mm) and occipital scalp (16.2 mm) [Figure - 1]b.

Figure 1: (a) Involutions seen over shaven scalp. (b) Lateral skull radiograph showing diffuse thickening over the entire scalp, with prominence over the frontal (12.3 mm) and occipital scalp (16.2 mm)

Patient 2: A 40-year-old lady presented with itching, headache and soft swelling over the scalp for the past 6 years. On examination, she had thickening of the skin over the vertex and left parietal area. Examination of the hair revealed no abnormaliy. Computed tomography (CT) of the head showed a diffuse peri-cranial soft swelling, with the prominence over the vertex measuring a maximum of 22.4 mm in thickness [Figure - 2]a.

Figure 2: (a) Computed tomography of the brain showing a diffuse pericranial soft-tissue swelling and prominence over the vertex measuring up to 22.4 mm thickness. (b) Biopsy of the scalp showing encroachment of thickened subcutis into the dermis, H and E, ×5

Both patients had no features of acromegaly, pachydermoperiostosis or myxedema. Histopathology of the scalp lesions of both these patients showed mild to focal moderate perivascular infiltrates of lymphocytes and histiocytes. There was no atrophy of hair follicles and pilosebaceous units. The subcutis was thickened, edematous and showed disruption of adipocyte architecture and integrity. It appeared to encroach into the dermis [Figure - 2]b.

A diagnosis of lipedematous scalp was made in these patients based on the clinical finding of boggy soft swelling of the scalp without alopecia, which on histopathology showed encroachment of thickened subcutis into the dermis. It was first described by Cornbleet in 1935. Coskey et al. introduced the term "lipoedematous alopecia" for a disorder which is characterised by an acquired, non-scarring, permanent alopecia or short hair that is unable to grow beyond a few centimetres, overlying thickened boggy subcutaneous tissue of the scalp. [1],[2] Recently Müller et al. proposed the term "localized lipomatosis of the scalp with or without alopecia" and suggested its classification within the group of conventional lipomatosis. [3]

The condition is characterized by boggy, soft, spongy or doughy thickening of the scalp that is predominantly located at the vertex and occiput, which is better palpated than visualized. Most of the reports are among women with rare reports in Caucasian men. A series of lipedematous scalp in ten Egyptian women who use tight head covers has been reported [4] The presenting symptoms in patients include diffuse pain, paraesthesias, headache, burning, aymptomatic scalp thickening and localised or generalized scalp tenderness or itching.

Increased scalp thickness is a characteristic feature resulting from increased thickening in the subcutaneous layer. Kavak et al. in their study have reported the average subcutaneous adipose tissue thickness between the galea aponeurotica and dermis in 78 Turkish subjects as 4.0 ± 0.94 mm by ultrasound. [5] The scalp thickness in patients with lipedematous scalp ranged from 9.2 to 16 mm. [5] Since there was no normative data available on scalp thickness in Indian subjects, we studied normal scalp thickness measured on the CT brain images of 30 patients including 16 males and 14 females with a mean age of 47.2 years (18-83 years). The mean scalp thickness at the frontal, parietal and occipital areas was 5.5 mm (2.8-8.1 mm), 7.1 mm (4-11 mm) and 7.75 mm (5-11 mm) respectively. These measurements were consistent with previous reports from other countries. Going by this data, scalp thickness in both our patients was greater than twice that of the normal population.

The histopathological changes include thickening of the subcutaneous tissue with encroachment into the dermis and distortion of fat architecture, dermal edema and ectatic lymphatics. [2] The pathogenesis remains unknown although mechanical factors like prolonged use of tight head gear and hormonal factors have been implicated. [4] Incidental associations include diabetes mellitus, renal failure, joint and skin hyperelasticity, Sjogren′s syndrome, hyperlipidemia and ovarian cysts. [2],[5] There is no definitive option for treatment or to halt progression of the condition. Our patients were initiated on antihistamines.

In conclusion, lipedematous scalp is a possible cause of dysesthetic syndrome of the scalp. In patients with no obvious cause for dysesthesia of the scalp, it is advisable that the scalp be palpated to identify this rare presentation that may otherwise be missed.

References
1.
Cornbleet T. Cutis verticis gyrata? Lipoma? Arch Derm Syphilol 1935;32:688.
[Google Scholar]
2.
Martín JM, Monteagudo C, Montesinos E, Guijarro J, Llombart B, Jordá E. Lipedematous scalp and lipedematous alopecia: A clinical and histologic analysis of 3 cases. J Am Acad Dermatol 2005;52:152-6.
[Google Scholar]
3.
Müller CS, Niclou M, Vogt T, Pföhler C. Lipedematous diseases of the scalp are not separate entities but part of a spectrum of lipomatous lesions. J Dtsch Dermatol Ges 2012;10:501-7.
[Google Scholar]
4.
El Darouti MA, Marzouk SA, Mashaly HM, El Nabarawi EA, Abdel-Halim MR, El Komy MM, et al. Lipedema and lipedematous alopecia: Report of 10 new cases. Eur J Dermatol 2007;17:351-2.
[Google Scholar]
5.
Kavak A, Yuceer D, Yildirim U, Baykal C, Sarisoy HT. Lipedematous scalp: A rare entity. J Dermatol 2008;35:102-5.
[Google Scholar]

Fulltext Views
407

PDF downloads
70
Show Sections