New onset eyebrow alopecia

Presenter: Matthew Koehler, DO

Dermatology Program: OPTI-West/College Medical Center

Program Director: Navid Nami, DO FAOCD

Submitted on: January 3, 2015

CHIEF COMPLAINT: Losing hair in his left eyebrow over a three week period

CLINICAL HISTORY: A 42-year-old Caucasian male presented to our clinic with a chief complaint that he was losing hair in his left eyebrow over a three week period. Before the onset of hair loss, he states he has noticed an enlarging “pimple” or “bite” growing under his eyebrow. The lesion was not painful and had no associated itching or burning sensation. He was, however, concerned with the aesthetics of the lesion and the possibility of continued growth. The patient has tried a mixture of hydrocortisone and clotrimazole cream to the area twice daily for the last week. During the first two weeks, the patient had tried cool compresses, but no treatments had any effect on the lesion. Family and social history are non-contributory.

PHYSICAL EXAM:
A 3×2 cm ill-defined indurated pink-to-red plaque with associated alopecia was noted on the left brow of the patient. A complete skin examination was done and no other concerning lesions were identified.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

A 3mm punch biopsy was done in the center of the lesion, within the area one would assume his eyebrow used to be. H&E staining showed the expansion of follicles secondary to spongiosis and likely mucin deposition. A mixed dermal infiltrate was found with lymphocytes, histiocytes, and eosinophils. Colloidal iron stain subsequently confirms mucin deposition.