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Amyloid-Associated Alopecia

A Reappraisal Including Its Pathophysiology

Magro, Cynthia M. MD*; Solomon, Garron J. MD; Kendrick, Mary Jo J. MD; Momtahen, Shabnam MD§

The American Journal of Dermatopathology: November 2019 - Volume 41 - Issue 11 - p 799–806
doi: 10.1097/DAD.0000000000001385
Original Study
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Abstract: Primary systemic amyloidosis has a varied clinical presentation, making it one of the great masqueraders of other disease entities in clinical medicine. The association of amyloidosis with alopecia is uncommon with at least 22 cases reported in the literature mostly in the setting of systemic amyloidosis. Alopecia in these patients occurs either as the initial presentation of the systemic amyloidosis or it happens during the disease course. The occurrence of amyloid alopecia associated with light chain (LC) restricted plasmacytic infiltrates in the absence of systemic amyloidosis, however, it is not well known. We report 3 cases of LC-associated amyloidosis presenting with alopecia, whereby there was evidence of a systemic plasma cell dyscrasia in 2 of the patients, one of whom developed multiple myeloma. None of the patients had systemic amyloidosis. Skin presentation in the patient with multiple myeloma was characterized by a diffuse form of alopecia affecting the entire scalp, eyebrow, and axillary and pubic hair in contrast to the localized form of alopecia noted in the other 2 patients. The mechanism by which LC-associated amyloidosis eventuates in this pattern of nonscarring alopecia potentially reflects the affinity of this form of amyloid for dermatan sulfate. Dermatan sulfate is found at highest concentrations within the adventitial dermis of the superficial to mid isthmic portions of the anagen hair follicles likely interfering with the hair cycle and induces early hair follicle involution. The result is a pattern of alopecia that can clinically and to some extent pathologically resemble either androgenetic alopecia or alopecia areata.

*Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY;

Dermatopathology at Tripoint Diagnostics, Morrisville, NC;

Dermatologists of Greater Columbus, Columbus, OH; and

§Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH.

Correspondence: Shabnam Momtahen, MD, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 (e-mail: shabnam.momtahen@hitchcock.org).

The authors declare no conflicts of interest.

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