51 yo M patient is seen in the clinic for the 3 month duration of itching, and some drainage and loss of hair. Patient had used Bactrim 1 month back for skin infection, which transiently helped with the scalp lesion as well. What are the DDx and how to approach this case.
Discussion. - Alopecia (Hair Loss)
- Scarring Alopecia (Permanent Hair Loss)
- Traction Alopecia
- Central Centrifugal Cicatricial Alopecia (CCCA)
- Lichen Planopilaris
- Lupus
- Non-Scarring Alopecia (Reversible Hair Loss)
- Metabolic Imbalance and Medications
- Etiology
- Women with PCOS,
- Thyroid Diseases
- Iron Deficiency
- Medication Side Effects (BB, Anti-convulsants, Oral retinoids, Warfarin)
- Often diffuse hair loss, difficult to distinguish from Telogen Effluvium
- Androgenetic Alopecia
- Male Pattern Alopecia
- Female Pattern Alopecia
- Treatment
- Topical Minoxidil
- Oral Finasteride
- Hair Transplantation
- Alopecia Areata: Alopecia Totalis (Whole scalp); Alopecia Universalis (Whole Body)
- Autoimmune condition that targets melanocytes at the base of the hair follicles. Hence, hair that regrows first are white.
- Well demarcated areas of hair loss
- Often circular and oval, may coalesce
- Absence of scales, or erythema
- Tapered "exclamation point" at the periphery
- Treatment: Intralesional Triamcinolone injection (5-10 mg / mL)
- Telogen (Final phase of hair development) Effuvium
- Caused by systemic stressful event (childbirth, surgery, serious illness)
- Usually Diffuse Hair loss that occurs 3-5 month after the inciting event
- Reference:
Further Discussion - Most likely DDx is Scarring Alopecia
- Note: Scalp Biopsy can help distinguish between scarring vs non-scarring alopecia
- DDX
- CCCA,
- Tinea Capitis (with superimposed bacterial infection)
- Trichophyton tonsurans (US)
- Microsporum canid (worldwide).
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