PMC8599928_01
The symptoms of the patient before treatment. (A) Large alopecia patches on the top of the scalp. (B,C) Erythematous plaques on the scalp and face, with irregular edges and slight scales on the surface. (D,E) Violaceous lichenoid papules and blisters can be seen on the back of hands and feet, with clear boundaries. (F,G) Papules could be seen on the trunk and arms.
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F1
A dermatology examination (Figure 1) showed large alopecia patches on the scalp, erythematous plaques on the scalp and face with irregular edges and slight scales on the surface, violaceous lichenoid papules, and blisters on the back of hands and feet with clear boundaries, and papules could be seen on the trunk and arms.
Indirect immunofluorescence of the frozen serum of the patient for IgG, IgA, and C3 was all negative.
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F2
IgG 2,040 mg/dl; ESR 58 mm/h; and BP180 was 8 RU/ml (normal value <20 RU/ml). Indirect immunofluorescent assay for IgG, IgA, and C3 were negative (Figure 2).
(A) Pathology of the scalp shows atrophy of the epidermis, hair follicle angle plug, liquefaction, and degeneration of basal cells, low infiltration of lymphocytes around the superficial dermis vessels, reduction of appendages, and deposition of a large amount of mucoprotein in the dermis. (B) Pathology of the upper arm shows hyperkeratosis of the epidermis, wedge-shaped thickening of the granular layer, liquefaction of basal cells, zonal infiltration of lymphocytes in the superficial dermis, and formation of epidermal fissures. (C1,C2) Pathology of the back of the patient's hand shows hyperkeratosis of the epidermis, wedge-shaped thickening of the granular layer, liquefaction of basal cells, zonal infiltration of lymphocytes in the superficial dermis, and subepidermal blisters.
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F3
Pathological examination (Figure 3) of the scalp showed epidermal atrophy, hair follicle angle plug, liquefaction, and degeneration of basal cells, infiltration around the superficial dermis vessels by a low number of lymphocytes, reduction of appendages, and deposition of a large amount of mucoprotein in the dermis.
The symptoms of the patient after 2 years of treatment. A small amount of hair had grown and all skin lesions had disappeared.
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F4
Upon recent follow-up, her symptoms are stable (Figure 4), her skin lesions have disappeared, and there has been some hair regrowth.