Abstract:

Alopecic and aseptic nodule of the scalp (AANS) is a likely underdiagnosed condition presenting with one or few inflammatory nodules of the scalp with overlying nonscarring alopecia. The nodules, which can be soft, fluctuant, or firm, are characterized by negative fungal and bacterial stains and cultures. Trichoscopic features such as black dots, yellow dots, fine vellus hairs, and broken hairs have been reported. Dilated follicular openings may be seen and are termed the “Eastern pancake sign” as they resemble the bubble cavities formed during cooking of atayef. Reported treatments include oral antibiotics such as doxycycline, intralesional corticosteroids, or excision. Although the etiology of AANS is currently unclear, a process of follicular plugging or a deep folliculitis sparing the bulge stem cells have been theorized. In this case, a 9-year-old boy presented with a soft, subcutaneous nodule with overlying alopecia on his right parietal scalp. The lesion was first noted 5 months prior to presenting to clinic. During that time, the nodule increased in size, became increasingly alopecic, and was complicated by intermittent pain. Excisional biopsy of the nodule revealed granulation tissue and mixed inflammation within the reticular to deep dermis with no definitive cystic cavity or cyst wall identified. Special stains for infectious organisms (Periodic acid-Schiff, Fite’s Acid Fast, and Twort’s Gram Stain) were negative. The patient’s post-operative course was uneventful, and no recurrence of the nodule was reported. Our case adds to the growing literature on AANS, including in the pediatric population.

Financial Disclosure:
No current or relevant financial relationships exist.

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Blake Chandler, MD