Hair loss in a 16-year-old girl

In 2014, a case study detailed the diagnosis and treatment of a 16-year-old girl experiencing progressive hair loss and thinning over her scalp, with visible areas of complete hair loss at the temples and back of the scalp, accompanied by scalp itchiness. She had no personal history of autoimmune disease but a family history of vitiligo. Examination revealed diffuse hair thinning and non-scarring hair loss with exclamation mark hairs visible on dermoscopy. Blood tests ruled out thyroid dysfunction and autoimmune markers. The initial diagnosis was alopecia areata, with telogen effluvium and lichen planopilaris as differential diagnoses. Treatment with clobetasol propionate 0.05% shampoo showed limited initial benefit, but some hair regrowth was observed after a month. Diagnostic punch biopsies confirmed alopecia areata. The patient continued treatment with clobetasol propionate shampoo and later scalp application, leading to significant hair regrowth at eight months, though some hair loss persisted at the vertex. Future management included clobetasol propionate for three-month bursts, tacrolimus ointment for stubborn areas, and consideration of intralesional triamcinolone if the condition worsened. The case highlighted alopecia areata as an autoimmune condition characterized by chronic inflammation of hair follicles, affecting 0.15% of the population with a lifetime risk of 1.7%. The prognosis is variable, with extensive disease or onset in childhood indicating a poorer prognosis. While no treatments alter the disease course, some can induce temporary regrowth. Psychological support is recommended due to the condition's impact on quality of life. NICE guidelines suggest management strategies based on the extent of hair loss and regrowth.