Subcutaneous necrobiotic granulomas of the scalp

Nine biopsy specimens taken from the scalps of five children and four adults with subcutaneous necrobiotic granulomas were reviewed. This histopathologic features were similar in both groups. Four of the five children presented clinically with multiple, firm, bound-down subcutaneous nodules limited to the scalp but no associated systemic disease. In addition to the scalp nodules, one child had typical cutaneous lesions of granuloma annulare over the acral areas. Two of the adult patients, however, had severe rheumatoid arthritis with multiple rheumatoid nodules on the arms in addition to the scalp nodules; one of them had rheumatoid vasculitis. Another adult patient had allergic granulomatosis,and one had granuloma annulare lesions involving the scalp, face, and left ankle. Excision biopsy specimens should be taken in all patients--both children and adults--with multiple, deep, bound-down nodules of the scalp. If the specimen shows subcutaneous necrobiotic granuloma, probably no treatment is indicated in children because, in our experience, there is no associated systemic disease. However, in the adult patient with similar scalp lesions, the possibility of systemic disease should be explored.