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Special Feature |

Picture of the Month—Diagnosis FREE

[+] Author Affiliations

Section Editor: Samir S. Shah, MD, MSCE

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Arch Pediatr Adolesc Med. 2010;164(7):674. doi:10.1001/archpediatrics.2010.109-b.
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A clinical diagnosis of halo scalp ring was made based on the history of prolonged pelvic pressure prior to delivery, caput succedaneum with extensive molding at birth, and a clinical picture of an annular alopecic ring on the fetal scalp that corresponded to areas of bony prominence. Halo scalp ring is a form of perinatal alopecia resulting from uterine, cervical, or vaginal pressure on the neonatal scalp that compromises blood flow and produces hypoxic-ischemic tissue damage.13Halo scalp ring usually occurs in babies born to primigravida mothers after a prolonged delivery and is attributed to caput succedaneum but cases following a Cesarean section have been reported.4Halo scalp ring can greatly vary in size and can range from mild alopecia to full-thickness necrosis. The diagnosis is made clinically based on typical history of prolonged or difficult labor resulting in extensive molding or caput succedaneum along with the typical location of the alopecic line along the areas of bony prominence extending from the parietal to occipital scalp in a ring.

Halo scalp ring is a localized physical phenomenon with no systemic associations and requires no further investigation or evaluation for congenital anomalies. The natural course of alopecia in most instances is partial regrowth of hair; however, a history of hemorrhagic or necrotic caput succedaneum is of more concern because deep scarring may destroy hair follicles, resulting in scarring alopecia.5Boney prominences of the parietal and occipital calvaria are likely under the greatest pressure and thus may experience ischemia during delivery, resulting in pressure necrosis. Observation is the most appropriate initial therapy once infection is ruled out. However, if scarring has occurred, consideration should be given to correction of the defect by tissue expansion and surgical excision of any residual areas of alopecia prior to school age to avoid psychological trauma common in children with cutaneous abnormalities. The incidence of halo scalp ring is unknown, with only 12 cases previously reported. However, with only 1 previous article in the pediatric literature and a frequently self-resolving natural history, the diagnosis is likely often not made.

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Correspondence:James Treat, MD, Department of Dermatology, Children's Hospital of Philadelphia, 3550 Market St, 2nd Floor, Philadelphia, PA 19104 (treat@email.chop.edu).

Accepted for Publication:January 21, 2010.

Author Contributions:Study concept and design: Anshelevich, Osterhoudt, and Treat. Acquisition of data: Introcaso and Treat. Analysis and interpretation of data: Anshelevich. Drafting of the manuscript: Anshelevich and Treat. Critical revision of the manuscript for important intellectual content: Anshelevich, Osterhoudt, and Introcaso. Administrative, technical, and material support: Anshelevich. Study supervision: Osterhoudt, Introcaso, and Treat.

Financial Disclosure:None reported.

Das  S Permanent baldness following caput succedaneum. J R Coll Gen Pract 1980;30 (216) 428- 429
PubMed
Johnson  NJohnson  VABannister  JLilford  RJ The effect of caput succedaneum on oxygen saturation measurements. Br J Obstet Gynaecol 1990;97 (6) 493- 498
PubMed Link to Article
Prendiville  JSEsterly  NB Halo scalp ring: a cause of scarring alopecia. Arch Dermatol 1987;123 (8) 992- 993
PubMed Link to Article
Patrizi  ASavoia  FNeri  IBardazzi  F An incomplete circle of alopecia: a new case of halo scalp ring? Acta Derm Venereol 2006;86 (1) 65- 66
PubMed
Tanzi  ELHornung  RLSilverberg  NB Halo scalp ring: a case series and review of the literature. Arch Pediatr Adolesc Med 2002;156 (2) 188- 190
PubMed Link to Article

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References

Das  S Permanent baldness following caput succedaneum. J R Coll Gen Pract 1980;30 (216) 428- 429
PubMed
Johnson  NJohnson  VABannister  JLilford  RJ The effect of caput succedaneum on oxygen saturation measurements. Br J Obstet Gynaecol 1990;97 (6) 493- 498
PubMed Link to Article
Prendiville  JSEsterly  NB Halo scalp ring: a cause of scarring alopecia. Arch Dermatol 1987;123 (8) 992- 993
PubMed Link to Article
Patrizi  ASavoia  FNeri  IBardazzi  F An incomplete circle of alopecia: a new case of halo scalp ring? Acta Derm Venereol 2006;86 (1) 65- 66
PubMed
Tanzi  ELHornung  RLSilverberg  NB Halo scalp ring: a case series and review of the literature. Arch Pediatr Adolesc Med 2002;156 (2) 188- 190
PubMed Link to Article

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