A 38-year-old man presents with rapid hair loss that has occurred over the last few weeks. He reports that his father had a similar condition.
The picture is shown below:
The most likely diagnosis is
A) Alopecia areata
B) Androgenic alopecia
C) Tinea capitis
E) Secondary syphilis
The answer is
A. (Alopecia areata)
Discussion: Alopecia areata is associated with sudden hair loss that occurs in round patches. The patches are well circumscribed and are not associated with scarring or inflammation. Patients
have no other symptoms. The most common area affected is the scalp; however, the condition may also affect the eyebrows or beard. Alopecia areata usually affects children and young adults and is recurrent. A pathognomonic sign for alopecia areata is the “exclamation point” hair, which is wide distally and narrower at the base. These hairs are often found at the periphery of a patch of hair loss. Hair that regrows in the area of alopecia areata is in many cases white. Nail pitting may also be present.
The treatment consists of injection of intralesional steroids and topical steroids. Most experience complete regrowth of hair.
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