Patches of hair loss by ProQuest


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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.

                                                   • THE CLINICAL ADVISOR • JULY 2010 63
                             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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