Halo scalp ring, a birth-related pressure injury, may, in rare severe cases, lead to permanent scarring alopecia, according to a recent case report.
A 12-year-old female patient presented with hair loss that had been noted shortly after birth. The patient was born at term via normal vaginal delivery; the pregnancy was complicated by oligohydramnios, but the delivery itself was uneventful. Caput succedaneum was observed at birth and resolved within days, although residual necrosis and ulceration persisted and later healed with scarring.
On examination, physicians observed a semi-annular band of cicatricial alopecia extending from the temporal to occipital scalp, measuring approximately 20 cm in length and 2 cm at its widest point. Dermoscopy revealed a homogenous white area with erythema, consistent with scarring. Based on these findings and the perinatal history, researchers diagnosed halo scalp ring.
Halo scalp ring is a form of alopecia caused by sustained pressure on the fetal scalp during labor, typically from the uterine cervix. The pattern and location of hair loss often reflect fetal positioning during delivery, producing a characteristic annular or band-like distribution that may involve the vertex and extend several centimeters, and typically presents within the first year of life.
The condition is frequently associated with caput succedaneum, a subcutaneous fluid collection resulting from prolonged pressure during labor. In most cases, halo scalp ring presents as temporary, non-scarring alopecia; however, more severe ischemia, pressure necrosis, and hypoxic injury to hair follicles may result in permanent cicatricial alopecia, as observed in this patient.
Key differential diagnoses include aplasia cutis congenita, vacuum delivery–associated alopecia, fetal scalp electrode–associated alopecia, and temporal triangular alopecia. Clinical history, lesion morphology, and dermoscopic findings—particularly absent follicular openings and white fibrotic areas—help distinguish halo scalp ring from these conditions.
Although the incidence of halo scalp ring is unknown and likely underreported, reported risk factors include primigravida status, prolonged labor, premature rupture of membranes, and prematurity. The condition is benign and not associated with systemic abnormalities. Management typically consists of observation and reassurance, with surgical options such as tissue expansion or excision considered for cosmetically significant cases.
As a single case report, these findings should be interpreted cautiously.
“Awareness regarding the benign nature of the condition will prevent unnecessary evaluation and medical treatment,” wrote lead study author Jeta Buch of NHL Municipal Medical College in Ahmedabad, India, and colleagues.
The researchers reported no conflicts of interest.
Source: JEADV Clinical Practice