Image Letter

Bullous Aplasia Cutis Congenita—Description of a Novel Dermoscopic Feature

Author Affiliation(s)

Case Presentation

A 1-year-old boy presented with a solitary alopecic atrophic area on the scalp and a history of a fluid-filled lesion at the site that had presented a few days after birth and healed with thinning of skin ( Figure 1A ). Examination revealed a 2 × 2 cm solitary, well-defined alopecic patch with atrophy on the scalp vertex without any underlying bone defect.

Figure 1 .

(A) Solitary alopecic patch with atrophic translucent skin and the (B) dermoscopic image with absent follicular openings, a few distended blood vessels (red arrow), a few visible pigmented hair bulbs (blue arrow), and cobblestoning (black arrows).

Dermoscopy revealed ( Figure 1B ) absent follicular openings, a few distended blood vessels, a few visible hair bulbs, and a branching network of reticulated white-colored streaks on atrophic skin resembling cobblestones.

Teaching Point

Although all signs may not be present in a case, the classic dermoscopic findings described are [ 1 ] : absence of follicular openings, thick, distended blood vessels, a hair collar sign with hair shafts arranged radially and forming a ring of hypertrichosis, and bulbs of anagen hair seen through the translucent epidermis resembling a golf stick [ 2 ] . However, recently a new pseudomembranous pattern has been identified, which can be included within a clinical and dermoscopic spectrum ranging from the classic to the pure membranous form of aplasia cutis congenita [ 3 ] . Of these findings, our case had only a few distended vessels but was absent hair collar and golf stick signs. However, the atrophic skin in our case presented as cobblestoning visible on dermoscopy, which is a unique feature of bullous aplasia cutis congenita.


  1. Aplasia cutis congenita: trichoscopy findings Costa Pinheiro AM, Silva Mauad EB, Amarante Fernandes LF, Bruno Drumond R. Int J Trichology.2016;8(4):184-185. CrossRef PubMed
  2. The trichoscopic “golf club set” sign for bullous aplasia cutis congenita Cutrone M, Grimalt R. Skin Appendage Disord.2018;4(4):320322. CrossRef PubMed
  3. Aplasia cutis: clinical, dermoscopic findings and management in 45 children Chessa MA, Filippi F, Patrizi A, et al. J Eur Acad Dermatol Venereol.2020;34(11):e724-e726. CrossRef PubMed

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