A Patient with Diffuse Hair Loss
January 2015
in “
Indian Dermatology Online Journal
”
diffuse alopecia areata biopsy follicular infundibulum pigment cast miniaturized dystrophic anagen follicle pigment incontinence fibrous tract remnant androgenetic alopecia telogen effluvium syphilis trichotillomania exclamation point hairs white hairs nail pits dermatoscopic findings yellow dots short vellus hairs peribulbar lymphocytic infiltrates follicular miniaturization catagen follicles telogen follicles oral corticosteroids topical corticosteroids contact immunotherapy phototherapy systemic immunosuppressive medications methotrexate AA follicle pigment hair follicle hair loss androgenic alopecia hair shedding hair pulling hair breakage white hair nail changes scalp examination yellow spots fine hair immune cells hair thinning hair growth phases hair shedding phases steroids topical steroids immune therapy light therapy immune suppressants
TLDR The patient's hair loss is most likely due to diffuse alopecia areata.
The document discusses a case of a patient with diffuse hair loss, concluding that the most likely diagnosis is diffuse alopecia areata (AA). The diagnosis was supported by a biopsy showing dilatation of the follicular infundibulum with a pigment cast, miniaturized dystrophic anagen follicle, and pigment incontinence within the fibrous tract remnant. Differential diagnosis of diffuse alopecia can include androgenetic alopecia, telogen effluvium, syphilis, and trichotillomania, but certain features such as the presence of exclamation point hairs, sparing of white hairs, nail pits, and specific dermatoscopic findings like yellow dots and short vellus hairs can help distinguish diffuse AA. Histopathological features of AA include sparse peribulbar lymphocytic infiltrates, follicular miniaturization, and an increase in catagen/telogen follicles. The prevalence of AA is 0.1-0.2% with a lifetime risk of 1.7%. Treatment options for AA include oral corticosteroids, topical corticosteroids, contact immunotherapy, phototherapy, and systemic immunosuppressive medications like methotrexate for refractory cases.
