Photo Quiz

Progressive Hair Loss

 

Am Fam Physician. 2017 Feb 1;95(3):183-184.

A 22-year-old active-duty service member presented with gradually progressive patchy hair loss on the scalp that began six weeks earlier. He was given intralesional steroid injections to decrease the hair loss. He returned six months later with widespread hair loss over his scalp and body, with minor sparing of the axillae and pubic region. After a two-month course of sulfasalazine (Azulfidine), his symptoms did not improve, and he had complete hair loss. He had a history of patchy hair loss five years earlier. He was otherwise healthy.

On physical examination, there was no hair noted anywhere on his body (Figure 1). The nail plates had a rough surface with longitudinal ridging (Figure 2). There was no visible scarring around the hair follicles. Laboratory examination revealed normal thyroid test results, and normal serum testosterone and estrogen levels.


Figure 1.


Figure 2.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

  • A. Alopecia totalis.

  • B. Alopecia universalis.

  • C. Androgenetic alopecia.

  • D. Cicatricial

Address correspondence to Brooke Caufield, MD, at brooke.harrison@yahoo.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Lew BL, Shin MK, Sim WY. Acute diffuse and total alopecia: a new subtype of alopecia areata with a favorable prognosis. J Am Acad Dermatol. 2009;60(1):85–93....

2. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62(2):177–188.

3. Kasumagic-Halilovic E, Prohic A. Nail changes in alopecia areata: frequency and clinical presentation. J Eur Acad Dermatol Venereol. 2009;23(2):240–241.

4. Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol. 2010;62(6):979–987.

5. Price VH. Treatment of hair loss. N Engl J Med. 1999;341(13):964–973.

6. Kaufman KD. Androgens and alopecia. Mol Cell Endocrinol. 2002;198(1–2):89–95.

7. Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias [published correction appears in J Am Acad Dermatol. 2005;53(3):496]. J Am Acad Dermatol. 2005;53(1):1–37.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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