Alopecia — Clinical Case (Wikimedia Commons)

Diagnosis: Alopecia

Guru the hairless chimpanzee in Mysore zoo.. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: This photograph was taken by Rijin S and released under the license stated below. You are free to use it for any purpose as long as you credit the author (Rijin S), the Source (Wikimedia Commons), the license (CC-BY-SA 4.0) in close relation to the image and send me a message This image is not public domain. Please respect the copyright protection. It may only be used

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