A Case of Neurodermatitis Circumscipta of Scalp Presenting as Patchy Alopecia
The present case report is about a 60-year-old female patient who presented to dermatology out-patient department with itchy scalp lesion of 2 years duration. She also had complaints of localized loss of hair in that area. There was no history of any local applications. There was no history of any drug intake. On examination, there was a localized area of alopecia of 4 cm × 4 cm size with underlying skin showing marked thickening to form a boggy swelling [] on the right parietoccipital region. There were no other skin lesions or hair and nail changes. Systemic examination was within the normal limits. Provisional diagnosis of LSC of scalp and tinea capitis was made. Woods lamp examination was negative and potassium hydroxide mount did not reveal any fungal hyphae. Routine blood and urine investigations, blood sugar, liver, renal and thyroid functions were normal. On further interrogation patients bystanders gave a history that patient at times uses rock stones to rub scalp and may continue rubbing until it bleeds. Skin biopsy revealed hyper keratosis hypergranulosis acanthosis thickening of collagen in dermis suggesting LSC. Patient was given intralesional injection of triamcinolone acetonide 2.5 mg/ml weekly for 4 weeks along with doxepin hydrochloride 10 mg at night. Patient was referred to Psychiatry Department for counseling. There was marked reduction in itching in the 1st week and complete regrowth of hair at end of 4 weeks. Doxepin was stopped after 3 months [Figures and ]. Patient came for follow-up monthly thereafter for 6 months with no relapse [].