Dermatology: Practical and Conceptual


Image Letter |  Dermatol Pract Concept 2021;11(2):e2021012 1

Dermatology Practical & Conceptual

Bullous Aplasia Cutis Congenita—Description of 
a Novel Dermoscopic Feature

Aradhana Rout1, Sandeep Arora1, Rajeshwari Dabas1, Debatraya Paul1 

1 Department of Dermatology, Command Hospital Air Force Bangalore, India 

Key words:  bullous aplasia cutis congenita, cobblestone pattern, developmental abnormality, congenital anomalies, dermoscopy

Citation: Rout A, Arora S, Dabas R, Paul D. Bullous aplasia cutis congenita—description of a novel dermoscopic feature. Dermatol Pract 
Concept. 2021;11(2):e2021012. DOI: https://doi.org/10.5826/dpc.1102a12

Accepted: July 30, 2020; Published: March 8, 2021

Copyright: ©2021 Rout et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-
NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and 
source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Sandeep Arora, MD, Department of Dermatology, Command Hospital Air Force, Bangalore 560007, India. Email: 
aroraderma@gmail.com

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. 

Dermoscopy revealed (Figure 1B) absent follicular open-

ings, a few distended blood vessels, a few visible hair bulbs, 

and a branching network of reticulated white-colored streaks 

on atrophic skin resembling cobblestones.

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). 



2 Image Letter |  Dermatol Pract Concept 2021;11(2):e2021012

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 identi-

fied, 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.

References
1. Costa Pinheiro AM, Silva Mauad EB, Amarante Fernandes LF, 

Bruno Drumond R. Aplasia cutis congenita: trichoscopy findings. 

Int J Trichology. 2016;8(4):184-185. DOI: 10.4103/ijt.ijt_90_15. 

PMID: 28442877.

2. Cutrone M, Grimalt R. The trichoscopic “golf club set” sign 

for bullous aplasia cutis congenita. Skin Appendage Disord. 

2018;4(4):320322.  DOI: 10.1159/000486463. PMID: 30410906.

3. Chessa MA, Filippi F, Patrizi A, et al. Aplasia cutis: clinical, 

 dermoscopic findings and management in 45 children. J Eur 

Acad Dermatol Venereol. 2020;34(11):e724-e726. DOI: 10.1111/

jdv.16542. doi:10.1111/jdv.16542. PMID: 32346876.