Circumscribed congenital alopecias harbouring dual lesions

Treatment of alopecia is often challenging for the clinician as it includes a spectrum of lesions ranging from congenital to acquired causes. We present three cases of congenital circumscribed alopecia, present since birth, clinically diagnosed as nevus sebaceous. Histopathological examination of the excised tissue showed syringocystadenoma papilliferum with dermatophytosis in one and nevus sebaceous with dermatophytosis in the other two cases. Although complete excision is the treatment of choice for these lesions, an antifungal agent is needed to eradicate the concurrent superficial mycosis. A careful histopathological examination of the lesional skin helps in identifying such unexpected dual lesions that would need further treatment.