Case Report Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy Vipawee Ounsakul, Wimolsiri Iamsumang, and Poonkiat Suchonwanit Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ailand Correspondence should be addressed to Poonkiat Suchonwanit; poonkiat@hotmail.com Received 30 September 2016; Accepted 27 November 2016 Academic Editor: Alireza Firooz Copyright © 2016 Vipawee Ounsakul et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Radiation-induced alopecia afer fuoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fstula embolization under fuoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic fnding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia. 1. Introduction Radiation-induced alopecia afer fuoroscopically guided procedures, although infrequently reported in the dermato- logical literature, is possibly becoming more common due to an increasing use of endovascular procedures. It is character- ized by geometric shapes of nonscarring alopecia confned to the area of radiation, usually asymptomatic without signs of scalp infammation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangu- lar, nonscarring alopecic patch on the occipital scalp, 1 month afer cerebral angiography with fstula embolization under fuoroscopy. His distinct clinical presentations together with a history of endovascular embolization under fuoroscopy were compatible with radiation-induced alopecia. 2. Case Report A 46-year-old Tai man presented with asymptomatic sharply demarcated rectangular balding patch on the occip- ital scalp of 2 weeks’ duration. Ten months earlier, he had a car accident and was diagnosed as having traumatic right carotid-cavernous fstula and optic neuropathy. Cerebral angiography revealed direct carotid-cavernous fstula from the C1 segment of cavernous part of the right internal carotid artery to the right cavernous sinus. Six months later, he was treated with transarterial balloon embolization without any complications. A month earlier, a follow-up magnetic resonance imaging and magnetic resonance angiography of the brain showed residual shunt. He underwent a cerebral angiogram with transvenous coil and glue embolization under fuoroscopy. Te total procedure duration and the total radiation exposure time were 150 minutes and 67 minutes, respectively. Te peak skin dose was 2.9Gy. Two weeks afer the procedure, he presented at the outpatient clinic with asymptomatic balding patch on his occipital scalp. Dermato- logic examination revealed a sharply demarcated rectangular nonscarring alopecic patch, measuring 10 × 12 centimeters in size, on the occipital scalp, without erythema or scaling (Figures 1 and 2). Hair pull test was positive in the periphery of the alopecic patch and revealed 100% telogen hairs. Other physical examinations were unremarkable, except for the fact that visual acuity of the right eye showed only light percep- tion. Dermoscopic examination of the alopecic area showed mostly yellow dots, black dots, short vellus hairs, and blue- grey dots in a target pattern around yellow dots and follicles (Figure 3). A 4 mm punch biopsy was performed and showed increased numbers of catagen and telogen hairs without perifollicular infltration (Figure 4). Correlating the clinical presentation, history of radiation exposure, and compatible Hindawi Publishing Corporation Case Reports in Dermatological Medicine Volume 2016, Article ID 8202469, 5 pages http://dx.doi.org/10.1155/2016/8202469