Alopecia — Clinical Case (Wikimedia Commons)

Diagnosis: Alopecia

Edwards' "Harlene" for the hair: the great hair dressing. Print. London: Edwards' "Harlene" Co., [1890's]. Wellcome Images Keywords: Hair; hair styling; Alopecia; Ephemera; Hair Preparations; edwards. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0).

Clinical Presentation

Alopecia areata: well-circumscribed, smooth, round patches of hair loss with exclamation point hairs. Androgenetic: progressive thinning in characteristic patterns (Hamilton-Norwood in men, Ludwig in women). Scarring: absent follicular ostia, erythema, scale.

Clinical History

Alopecia areata: autoimmune associations (thyroid, vitiligo). Telogen effluvium: onset 2-3 months after stressor (illness, surgery, pregnancy, weight loss). Androgenetic: family history. Assess medications, diet, thyroid function, iron stores.

Treatment

AA: topical/intralesional corticosteroids, topical minoxidil, JAK inhibitors (baricitinib — FDA-approved). AGA: minoxidil, finasteride/dutasteride, low-level laser therapy, PRP, hair transplantation. Scarring: treat inflammation to prevent progression.

Differential Diagnosis

Alopecia areata, Androgenetic alopecia, Telogen effluvium, Traction alopecia, Tinea capitis, Lichen planopilaris, Frontal fibrosing alopecia, Trichotillomania

Key Learnings

Pull test helps quantify active shedding. Trichoscopy reveals yellow dots (AA), miniaturized hairs (AGA). Baricitinib is the first FDA-approved systemic treatment for severe alopecia areata. Scarring alopecias require biopsy for classification.

Tags: alopecia, hair loss, autoimmune, dermatology