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March 2003
By Stephen Schleicher, MD, and Lawrence
Schiffman, DO
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CASE:
A 52-year-old woman presents to the office complaining of
hair loss, which is confined to the back of her head. She
says it began approximately nine months ago as one small hairless
patch that has progressively spread, though it remains asymptomatic.
Psychologically, she is distraught over her condition. She
says she is not being treated for any other health problems.
Noted on the posterior occipital scalp are
two sizeable bald patches. Within the patches are small white
wispy hairs. The scalp is otherwise normal.
WHAT IS YOUR DIAGNOSIS?
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Ophiasis alopecia areata is a type of hair loss seen most often
in middle-aged women. It occurs bilaterally on the occipital
and temporal scalp as bald patches that may be discrete or confluent.
Alopecia areata is thought to have an autoimmune etiology. Treatment
of the ophiasis variant is difficult; in some patients it may
respond to intralesional injections of triamcinolone acetonide.
Other treatment options include topical steroids, anthralin,
tacrolimus, pimecolimus, and imiquimod. Fine, downy white hairs
are first to appear as the condition resolves. |
Dr. Schleicher is director of the DermDx Centers
for Dermatology of Northeastern Pennsylvania and a clinical instructor
of dermatology at Graduate Hospital's City Line Campus in Philadelphia,
Kings College in Wilkes-Barre, and Arcadia University in Glenside,
Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial
board. Dr. Schiffman is a fellow at the DermDx Centers for Dermatology.
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