38 CLINICAL
Can you pinpoint these causes of alopecia ?
Hair loss is relatively common and can have many causes . Can you identify what lies behind these cases ? Answers can be found at the foot of the page
1
A 45-year-old woman has some bald patches that have normal skin at their base and some broken-off hairs around the edge . What is the likely diagnosis ?
Alopecia areata Telogen effluvium Central centrifugal cicatricial alopecia ( CCCA )
Tinea capitis
2
An eight-year-old African-Caribbean girl has some areas of hair loss . On examination you note a scaly scalp . Which of the four options is the likely cause ?
Alopecia areata Telogen effluvium Central centrifugal cicatricial alopecia ( CCCA )
Tinea capitis
3
A 47-year-old woman has noticed hair falling out , but no bald patches . This is distressing her , and comes after a stressful year dealing with a premature baby . Which of the possible diagnoses is indicated ?
Alopecia areata Telogen effluvium Central centrifugal cicatricial alopecia ( CCCA )
Tinea capitis
4
A woman in her 30s has hair loss from the crown of her head , spreading forwards . The exposed skin seems rough - what diagnosis does this lead you to suspect ?
Alopecia areata Telogen effluvium Central centrifugal cicatricial alopecia CCCA
Tinea capitis
Answers 1 Alopecia areata This is alopecia areata : bald patches with pathognomic ‘ exclamation mark ’ hairs around the edge – short hairs that appear broken off . The eyebrows and eyelashes may also be affected . 2 Tinea capitis This is a fungal scalp infection , more common in those of African-Caribbean ethnicity . The scalp is scaly and often itchy . Management is with oral antifungals . 3 Telogen effluvium This is a disturbance of the hair cycle , occurring after life events such as childbirth or illness . The hair grows back over months but it is useful to exclude thyroid disease and iron deficiency . 4 Central centrifugal cicatricial alopecia . CCCA is a scarring alopecia , more common in women . Traction from hair-straighteners may contribute . There is generally no treatment .
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