A Case of Unusual Comedogenesis in Alopecia Totalis

The document presents a rare case of a 19-year-old male with a 3-year history of alopecia totalis, a condition causing total hair loss, who developed multiple blackhead-like lesions on his bald scalp. The study supports the hypothesis that the absence of terminal hair, which normally helps drain sebum and prevent acne, can lead to the formation of these lesions, known as comedones. The patient's condition did not improve with the application of various oils and lotions. The patient was prescribed oral isotretinoin and comedone extraction, but was lost to follow-up after 2 months. The case emphasizes the importance of terminal hair as a natural drain for pilosebaceous unit secretions and suggests that the absence of this hair can lead to the development of comedones, cysts, and milia, provided the pilosebaceous units are not completely destroyed.