Granulomatous Inflammation in Alopecia Areata: A Diagnostic Pitfall

Alopecia areata (AA) is typically characterized by nonscarring hair loss due to an autoimmune attack on hair follicles. However, granulomatous inflammation associated with AA is rare and can complicate diagnosis. This case study of a 27-year-old man with patchy hair loss revealed granulomatous inflammation upon histopathological examination, which is unusual for AA. The patient was treated with intralesional triamcinolone, resulting in complete hair regrowth within 2 months. Granulomatous inflammation in AA may occur due to immune responses to follicular damage, and while it resembles other granulomatous conditions, it requires careful differentiation to avoid misdiagnosis. Treatment remains similar to conventional AA, primarily involving corticosteroids. Recognizing this rare manifestation is crucial to prevent unnecessary investigations for infectious or systemic granulomatous disorders.