We report the case of a 40-year-old diabetic patient on insulin. Followed since 2014 for a dermatofibrosarcoma of Darrier Ferrand operated four times and then received adjuvant radiotherapy on the scalp (total dose of 66Gy), under clinical monitoring.

One of the most troubling and depressing complication for patients who received radiation in the scalp for a tumour process is alopecia, which in some cases can be scarring and have a significant psychological impact on the patient's quality of life [1,2].

We report the case of a 40-year-old diabetic patient on insulin. Followed since 2014 for a dermatofibrosarcoma of Darrier Ferrand operated four times and then received adjuvant radiotherapy on the scalp (total dose of 66Gy), under clinical monitoring. The patient presented after her radiotherapy sessions, a diffuse alopecia on the scalp and referred to us for management. On clinical examination, the patient was conscious and stable. Dermatological examination found a diffuse scarring alopecia of the vertex centered by an atrophic scar, the traction sign was negative on the entire scalp and the rest of the somatic examination was normal. Dermoscopic examination revealed a central scarring alopecia with peripheral fluffy and leucotrichic hair, coiled hair, blackheads, whiteheads and pigmented areas without structures.

Hair loss, temporary or permanent, is one of the most stressful side effects for patients undergoing oncologic treatment. The true prevalence of permanent alopecia by radiation may be underestimated as many patients do not complain and accept it as the price of the treatment [3]. 

Figure 1: Clinical picture of scarring alopecia of the vertex centered by an atrophic scar.