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April 1998

Woman With New-Onset Boggy Scalp

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Arch Dermatol. 1998;134(4):499-504. doi:

The thickness of the scalp measured by head ultrasound was 12.3 mm (Figure 4), and the scalp was ballotable down to 9.3 mm with the ultrasound probe (Figure 5). A comparison measurement of a normal scalp revealed a vertex scalp depth of 6.1 mm.

In 1935, Cornbleet1 described a lipedematous process in the scalp of a 44-year old black woman who "felt as if [her scalp] were underlaid with cotton batting." However, no hair abnormalities were present. A biopsy specimen of the scalp was normal except for an abnormally thick subcutaneous fat layer. Coskey et al2 used the term lipedematous alopecia in 1961 for 2 cases involving shortened hairs and an increased subcutaneous fat layer. Scalp thickness was measured by introducing a needle into the vertex and was found to be 10 to 13 mm, with 8 to 13 mm of subcutis. Curtis and Heising3 reported a fourth case of lipedematous alopecia, which was associated with hyperelasticity of the skin and joints, with a measured scalp thickness of 15 mm. In 1994, Lee et al4 described a case of "lipedematous scalp" in a woman with findings similar to those in Cornbleet's case. Scalp thickness was measured by computed tomography and found to be 10.7 mm, with a subcutaneous fat layer of 8.5 mm. Lee and colleagues made the distinction between lipedematous alopecia and lipedematous scalp, the former being associated with hair growth abnormalities. For comparison, Garn et al5 evaluated 523 healthy adults using lateral skull roentgenograms and found that the average scalp thickness at the bregma was 5.8±0.12 (mean±SD) mm.

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