|
March 2005
By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
|
|
|
CASE:
An 11-year-old girl presents with hair loss that has progressed
for two years. Her medical history is negative for systemic
disease, including thyroid abnormality. She comes from a broken
home and is said to be under a lot of stress. Numerous treatments
have been attempted in the past, but none has been effective.
On physical exam, she appears generally healthy. The area
of hair loss is a large triangular patch on the right parietal
scalp, with no erythema or scale. Small, white, wispy hairs
are present on the periphery of the bald area.
WHAT IS YOUR DIAGNOSIS?
|
| |
| |
|
|
|
The cause of alopecia areata (AA) is unknown, but it is thought
to be immune-mediated. Some cases are related to thyroid dysfunction,
and others are ascribed to stress. The condition becomes evident
by age 20 in half of all cases and has no gender predilection.
Most cases resolve on their own, but relapses are common. Treatment
of smaller patches of AA usually entails both topical and intralesional
steroids. Hairs may initially grow without pigment. Anthralin,
imiquimod, and topical minoxidil have also been used, with variable
success. This patient's condition continued to progress, eventually
leading to complete loss of hair (alopecia totalis). |
|
Dr. Schiffman is a fellow at DermDx Centers
for Dermatology of Northeastern Pennsylvania, headquartered
in Hazelton. Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 37(3):31-32, 2005
|
|
