10.5826/dpc.1203a93
text/xml
2160-9381
2064
en
Adrián Imbernón-Moya
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
intracranial aneurysm
Square-shaped alopecia after embolization of intracranial aneurysm: case report and review
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-09-24
2022-07-28
2022-09-13
e2022093
Dermatol Pract Concept
Adrián Imbernón-Moya
2022/07/28
10.5826/dpc.1203a93
e2022093
Department of Dermatology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
2160-9381
intracranial aneurysm
en
e2022093
Cho S, Choi MJ, Lee JS, Zheng Z, Kim DY. Dermoscopic findings in radiation-induced alopecia after angioembolization. Dermatology. 2014;229:141–145. DOI: 10.1159/000362810. PMID:25171463.
Square-shaped alopecia after embolization of intracranial aneurysm: case report and review
https://dpcj.org/index.php/dpc/article/download/2064/1697
                    Dermatology Practical & Conceptual


     Square-shaped Alopecia After Embolization of
   Intracranial Aneurysm: a Case Report and Review
             Jorge Román-Sainz1, Nicolás Silvestre-Torner1, Fernando Gruber-Velasco1,
            Belen Romero-Jiménez1, Alejandro Lobato-Berezo2, Adrián Imbernón-Moya1


1 Department of Dermatology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
2 Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain



Key words: Alopecia, radiation, trichoscopy, intracranial aneurysm
Citation: Román-Sainz J, Silvestre- Torner N, Gruber- Velasco F, Romero- Jiménez B. Square-shaped alopecia after embolization of
intracranial aneurysm: case report and review. Dermatol Pract Concept. 2022;12(3):e2022093. DOI: https://doi.org/10.5826/dpc.1203a93
Accepted: October 15, 2021; Published: July 2022
Copyright: ©2022 Román-Sainz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (BY-NC-4.0), https://creativecomm ons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Jorge Román Sainz, MD, Travesía de Téllez 8, 7º R. CP: 28007, Madrid, Phone: 680653019,
E-Mail: jorgesheldon@gmail.com




Introduction                                                             follicles without signs of fibrosis. After 2 months the patient
                                                                         showed complete hair regrowth without treatment.
Endovascular interventional procedures are widely used
for intracranial arterial pathologies treatment. They require
realization of fluoroscopy, a technique that relies on X-rays
                                                                         Conclusions
to obtain real-time images [1]. Many cases of transient                  Transient radiation alopecia (TRA) is an adverse effect, which
alopecia after this procedure have been reported.                        usually appears with accumulated doses between 3-6 Gy.
                                                                         Greater doses than 6 Gy may cause scarring alopecia [1,2].
Case Presentation                                                        This is caused by the simultaneous entry of multiple follicular
                                                                         cells in catagen phase. The dose of radiation produced by a
A 45-year-old male was admitted with an intracranial hemor-              fluoroscopy unit is usually between 0.02-0.05 Gy/min.
rhage after a rupture of an aneurysm in the anterior commu-                   Fifty-eight cases of TRA have been reported after intra-
nicating artery. Two embolization procedures were required.              cranial arterial embolization, being more frequent in women,
After 2 weeks, he experienced a partial hair loss, comprising            with a ratio of 1.41:1. The age varies from 13 years to
the left temporoparietal scalp region. A 7,5-cm sized alope-             70 years, but most of the patients were between 30-50 years.
cia plaque with angular edges and rectangular morphology                 Patients report sudden hair loss, producing plaques of alope-
was observed (Figure 1). Pull test was positive. Trichos-                cia whose size and shape vary depending on the model of the
copy showed black dots and short vellus hairs (Figure 2).                device used. The characteristic angular edges and the medical
Lack of peladic hairs ruled out alopecia areata. Skin biopsy             history are essential for the differential diagnosis with alope-
revealed multiple pilosebaceous units with obliterated                   cia areata [1,2].


Research Letter | Dermatol Pract Concept. 2022;12(3):e2022093                                                                           1
    Figure 1. Alopecia area in the patient left temporoparietal region. Note the angular edges which give it
    a perfectly square contour.




    Figure 2. Trichoscopy performed on the edge of the alopecia area. Black dots can be observed, as well as
    short vellus hair.




2                                                             Research Letter | Dermatol Pract Concept. 2022;12(3):e2022093
   The cumulative radiation dose was in most cases greater         cases, cryotherapy, topical corticosteroids, topical minoxi-
than 3 Gy, with 92% of cases ranging between 3-6 Gy [1].           dil and/or intralesional triamcinolone were applied, without
Only one case of scarring TRA has been reported [2]. In the        significant differences compared to untreated patients [2].
case of our patient, we do not know the exact dose of radia-          TRA is a transient condition that resolves without the
tion received, but a total dose greater than 3 Gy was estimated.   need of treatment. Given the increase of such interventional
   In trichoscopy, the most common findings include black          procedures in recent years, it is important to know this entity
dots and yellow dots, followed by short, vellus hairs. Broken      and differentiate it mainly from alopecia areata. It should
hairs and white dots are less common [2]. These findings           also be considered adding this side effect to the informed
can be observed in alopecia areata. However, exclamation           consent of such interventions.
hairs are often seen in the latter, a finding that is not pres-
ent in TRA.
                                                                   References
   Histological findings show anagen or catagen follicles
lacking inflammatory infiltrate or scar tissue [2]. Differential    1. Freysz M, Mertz L, Lipsker D. Temporary localized alopecia fol-
diagnosis should be made mainly with alopecia areata, in               lowing neuroradiological procedures: 18 cases. Ann Dermatol
                                                                       Venereol. 2014;141;15-22. DOI: 10.1016/j.annder.2013.09.655.
which a peri- or intra-bulbar lymphocytic infiltrate with a
                                                                       PMID: 24461089.
“honey-comb” image is usually observed.
                                                                    2. Cho S, Choi MJ, Lee JS, Zheng Z, Kim DY. Dermoscopic findings
   Time from the embolization procedure to the onset of                in radiation-induced alopecia after angioembolization. Derma-
alopecia ranges from 1-8 weeks. Most cases spontaneously               tology. 2014;229:141–145. DOI: 10.1159/000362810. PMID:
resolve between 2-6 months, with complete regrowth. In some            25171463.




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022093                                                                       3
