Supplementary Material for: Lipedematous scalp occurring in two female siblings: further evidence for a genetic role

Introduction
Lipedematous scalp (LS) is a rare disorder characterised by thickening of the adipose subcutaneous scalp layer without associated hair loss. To date there have been fewer than 100 reported cases of LS. LS occurring in siblings has not been previously reported.

Case Presentation
We present a 58-year-old and 63-year-old pair of black Caribbean female siblings with LS. Scalp thickness on ultrasound of the vertex in each case was 12mm and 11mm from skin to periosteum respectively (normal range 5-6mm). Histopathological analysis in the younger sibling demonstrated prominent fat high in the dermis around hair follicles, with follicular distortion and focal perifollicular fibrosis. Co-morbidities in the younger sibling were obesity (body mass index [BMI] 39.0), paranoid schizophrenia and bipolar disorder; the older sibling was overweight (BMI 26.0) with co-morbidities of hypercholesterolaemia, type 2 diabetes mellitus, hypomania, migraines. Both siblings were taking psychiatric medication.

Discussion/Conclusion.
We present an unusual case of LS in a pair of female siblings, adding to the limited existing evidence that there may be a genetic role in the pathogenesis of LS. Furthermore, both of the siblings in this case had psychiatric co-morbidites and were taking psychiatric medication, which have not been previously identified as associations of LS.