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JAMA Dermatology Clinicopathological Challenge
January 2016

Localized Hair Repigmentation in a 91-Year-Old Woman

Author Affiliations
  • 1Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
JAMA Dermatol. 2016;152(1):81-82. doi:10.1001/jamadermatol.2015.3812

A 91-year-old woman presented to our clinic after her hairdresser advised her to see a dermatologist because she had detected a patch of black hair within the otherwise gray hair of this patient. Examination revealed a patch of heavily pigmented black hair on the back of the scalp (Figure, A), while the rest remained gray. On the underlying scalp skin, there was an irregularly pigmented, brownish patch about 4 × 3 cm in size. Dermatoscopic examination showed an irregular pigmentation pattern with asymmetric pigmented follicular openings and pronounced perifollicular hyperpigmentation, black and slate gray dots, and black, unstructured areas (Figure, B). Full skin examination showed multiple seborrhoic keratoses and a single actinic keratosis on the left side of her forehead, but findings were otherwise unremarkable. Lymph node examination did not reveal any abnormalities. The patient’s natural hair color before graying was brown. Five years previously, she had been diagnosed as having lentigo maligna on her right cheek, which was treated with grenz ray radiotherapy.1 It responded well but recurred 2 years later and was excised using microscopically controlled excision. She had not been seen by a dermatologist in 18 months. Her medical history was otherwise unremarkable. She was not taking any medications at the time of presentation. A 3-mm punch biopsy specimen was taken from the middle of the lesion and sent for histopathological evaluation (Figure, C and D).