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Case Reports
. 2021 Aug;7(5):387-392.
doi: 10.1159/000514698. Epub 2021 Apr 13.

Atypical Congenital Triangular Alopecia (Brauer Nevus): Case Report and Review of Literature in Occipital and Mid-Frontal Localizations

Ana Rodríguez-Villa Lario  1   2 , Juan Ferrando  3 , Óscar M Moreno-Arrones  4   5 , Alba Gómez-Zubiaur  1   2
Affiliations
Case Reports

Atypical Congenital Triangular Alopecia (Brauer Nevus): Case Report and Review of Literature in Occipital and Mid-Frontal Localizations

Ana Rodríguez-Villa Lario et al. Skin Appendage Disord. 2021 Aug.

Abstract

Introduction: Brauer nevus, also known as congenital triangular alopecia (CTA) is a localized alopecia that rarely affects the occipital or mid-frontal region. CTA is a localized follicular hypoplasia, commonly misdiagnosed as alopecia areata. Although named congenital, onset in adulthood is possible.

Case presentation: We present a review of literature of eighteen atypical locations, providing 4 new cases to the 9 previously published, with particular attention to trichoscopy and histopathological descriptions in this exceptional presentation forms.

Discussion: Occipital and mid-frontal Brauer nevus are unusual findings with very few cases reported so far. Because of its rarity and atypical presentation, it can often lead to a misdiagnosis. A higher incidence in the male sex stands clear in these locations. Detection at birth is slightly more frequent than in the classical CTA. Histopathological and trichoscopy findings do not differ from the classical entity, although white or hypopigmented hairs do not seem to be an item present in the mid-frontal forms.

Keywords: Alopecia; Atypical location; Brauer nevus; Follicular hypoplasia; Trichoscopy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
a Lancet-shape left occipital alopecic plaque. b Trichoscopy findings, short and thin vellus hairs (black arrows), and white hairs (red arrows). c Left lancet-shape inferior occipital patch. d Trichoscopy examination where vellus hair with length diversity is detected (black arrows). e Alopecic mid-frontal patch stable. f Vellus hairs and 1 coiled hair (yellow arrow). g, h Mid-frontal alopecic patch with trichoscopy features were consistent with Brauer nevus.
Fig. 2
Fig. 2
a HE ×4; general view of a longitudinal section showing a decreased amount of terminal hair follicles. b HE ×10; closer look up, immature vellus hair. c HE ×4; transversal section in middle dermis where an increased amount of vellus hairs is noted. d HE; shaved biopsy panoramic showing follicular hypoplasia.
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