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CME Dermatologic Look-Alikes ■ LEARNING OBJECTIVE: To improve the clinician’s ability to distinguish and properly CE treat dermatologic conditions with similar presentations. ■ COMPLETE THE POSTTEST: Page 66 ■ ADDITIONAL CME/CE: Pages 23, 43 Patches of hair loss BY SEAN D. DOHERTY, MD CASE #1 CASE #2 A teenaged boy presented with a six-month history of A boy aged 7 years presented to the pediatric dermatol- patchy alopecia over his scalp. Four years ago, he had a ogy clinic with a patch of alopecia over his right temple similar episode of hair loss that resolved spontaneously that had been present since birth. The patient’s mother after a few months. His mother had experienced episodes said that her son was born with minimal hair over his of patchy hair loss that had resolved spontaneously. Six scalp. He developed thicker and more darkly colored hair months earlier, the patient noted clumps of hair loss elsewhere on his scalp, but hair never seemed to grow resulting in three patches of alopecia over his occipital over this area. The patch of alopecia was not increasing scalp. Two of the patches resolved, but one did not. in size, no hair loss was noted, and the area was asymp- Physical examination revealed one well-circumscribed tomatic. The patient had no known medical problems, circular patch of alopecia on the right occipital scalp. and there was no family history of alopecia. www.clinicaladvisor.com • THE CLINICAL ADVISOR • JULY 2010 63 CME CE Dermatologic Look-Alikes CASE #1 Alopecia areata systemic lupus erythematosus, diabetes mellitus, and myas- thenia gravis; however, most cases of AA are not associated Alopecia areata (AA) is a non- with other diseases. Screening for associated conditions is scarring hair loss that most generally not performed unless the patient presents with commonly occurs over the associated signs or symptoms.1 scalp but can occur over any The differential diagnosis of AA includes trichotilloma- hair-bearing portion of the nia, tinea capitis, temporal triangular alopecia, traction body. AA is an autoimmune alopecia, secondary syphilis, and loose anagen syndrome.2 condition in which activated Clues that the condition is AA include a history of periodic T-lymphocytes target hair fol- regrowth, nail pitting, and the presence of “exclamation licles. Some evidence points point” hairs.1 If the type of alopecia cannot be differenti- to follicular melanocytes as ated on the basis of history, a scal
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