TICK WITH TREAT

Ticks can determine various local reactions, among which scarring and nonscarring inflammatory alopecia. We describe a case of nonscarring alopecia in a two-year-old girl of Romanian origin who reported a recent history of tick bite. She referred to our pediatric department with diffuse alopecia of the scalp, in which there was an erythematous nodule, presumed site of the tick bite accursed two months prior. She did not develop fever, arthralgias or other systemic symptoms. In order to exclude autoimmune diseases and infectious etiologies, we performed laboratory exams, such as anti-thyroid, antinuclear, anti-transglutaminase, TORCH and anti-Borrelia antibodies, resulted negative. A punch biopsy specimen from the scalp (0.4×0.3×0.2 cm) revealed fibrosis of the derma and the peripheric areas of pili-sebaceous annexes. The following month, we observed a rapid centrifugal progression to total alopecia. Thus, we decided to attempt therapy with topic corticosteroids followed by a progressive hair regrowth during the following four months. Tick bite alopecia was first described in 1921. Since then, a few other cases have been reported in the international literature. The characteristic manifestation is a single zone of alopecia, often with a centrifugal spread, that appears 1–2 weeks after the tick removal. Sometimes, it can be associated with a central eschar, representing the site of tick bite. The nonscarring forms of alopecia manifest as ‘moth-eaten’ patches or, in alternative, as nodular or blood-crusted lesions. Clinically, patients may present with pain, pruritus or swelling. The precise mechanism for hair loss is not well understood but it is assumed to be caused by the host inflammatory response to tick saliva antigens. The result is the destruction of hair follicles or the alteration of the catagen/telogen phase. Histologic findings may show a heterogeneous inflammatory infiltrate and areas of fibrosis. The international literature does not report effective therapy for tick bite alopecia, while treatment with topic corticosteroids for alopecia areata is recognized. Prognosis is favourable with a complete hair regrowth usually within 3 months, although in some cases alopecia is reported to persist for 5 years