The biopsy specimen revealed mild spongiosis, with some lymphocytic exocytosis in the epidermis. The superficial dermis showed a moderate perivascular mononuclear inflammatory infiltrate. Within the deep dermis, "naked" granulomas were found. Special stains failed to reveal any organisms.
Chest radiography showed bilateral hilar and mediastinal lymphadenopathy. The serum angiotensin-converting enzyme level was 66.7 nmol/min (reference range, 30-50 nmol/min). Radiographs of the patient's hands and feet revealed no abnormalities, and his serum calcium levels, as well as the results of his ophthalmologic examination, were normal.
An Unusual Cause of Hair Loss. Arch Dermatol. 2002;138(2):259-264. doi:10.1001/archderm.138.2.259