Primary systemic amyloidosis causing diffuse alopecia by telogen arrest.

To the Editor.— The primary and myeloma-associated forms of systemic amyloidosis are frequently associated with cutaneous manifestations, ie, purpuric lesions due to amyloid in vessel walls, or smooth waxy papules, plaques, and nodules due to dermal amyloid deposits. 1,2 Alopecia is less common but may occur as part of the clinical spectrum of established disease or, rarely, as a sign of occult amyloidosis. 3,4 We report a patient whose diffuse alopecia led to the diagnosis of primary systemic amyloidosis. The histopathologic changes in serial biopsy specimens demonstrate that amyloid inhibits anagen restoration of hair follicles, perhaps by vascular impairment. Report of a Case.— A 59-year-old, asymptomatic, white woman presented with a 4-month history of diffuse scalp alopecia (Fig 1), generalized thinning of body hair, and easy bruisability. Physical examination revealed a greater than 50% reduction in scalp hair density, positive hair pulls, increased hair part widths, and microscopically normal hair