Abstract

Pressure-induced alopecia (PA) also known as postoperative alopecia is a rarely diagnosed pattern of scarring and non-scarring hair loss in patients following extended periods of immobilization. The widely accepted pathophysiology is tissue ischemia in the similitude of pressure ulcers developing within one to three weeks of immobilization. In the development of PA, the duration of the pressure has been reported to be more important than intensity. We report a case of a 46-year-old woman who presented with two patches of hair loss on her occiput three weeks after a 12-hour bilateral mastectomy and subsequent ICU admission. She reported crusting and hair shedding that occurred 1 week following her surgery. Physical examination revealed two completely alopecic patches on the right and left occiput with mottled pigmentation and surrounding broken hairs. PA was suspected based on her clinical history. A punch biopsy of the edge of the lesion, revealed a significant loss of hair follicles in the deep dermis with replacement by mucinous tracts and eosinophilic material consistent with permanently involuted follicles. Some of the tracts showed markedly atrophic epithelia; there was no significant infiltrate and no pigment casts. The histomorphologic findings in our patient contribute to only a handful of previously described cases of PA in the literature. The varying histopathologic findings of PA may reflect a sampling of the process at different stages of its evolution, or at different levels of severity. The diagnosis of PA requires a strong clinical suspicion and adequate trichoscopic and histologic examination.

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