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A Single Question Can Make the Diagnosis
CASE REPORT
A Single Question Can Make the Diagnosis Vera H. Price1 Alopecia areata is the only condition that can cause complete hair loss in 3 months without symptoms or signs. Journal of Investigative Dermatology Symposium Proceedings (2013) 16, S65–S66; doi:10.1038/jidsymp.2013.27
PRESENTATION A 58-year-old woman presented with asymptomatic, impressive hair loss over the entire top of her scalp. Figure 1.
INVESTIGATIONS The single question that was the key to diagnosis: ‘‘How long have you had this?’’ Her response: ‘‘Three months.’’ CBC (complete blood count), TSH (thyroid-stimulating hormone), ferritin, and vitamin D25OH were normal. MANAGEMENT The presence of follicular markings ruled out a scarring alopecia. Alopecia areata is the only condition that can cause complete hair loss in 3 months without symptoms or signs. No treatment was given and she was asked to return for follow-up in 3 months.
HISTORY Before the dramatic loss she had a full head of hair. There was no history of patchy hair loss, atopy, thyroid problems, or vitiligo.
OUTCOME Three months later, she had impressive white hair regrowth. Figure 2.
EXAMINATION Almost total loss of hair over the top of her scalp. Follicular markings were present and appeared normal. There was no inflammation or scaling. She had no other areas of hair loss.
DISCUSSION Alopecia areata is usually easy to diagnose, but visits are time consuming because of the variables that the patient needs to know for a long-term view of the condition: it is highly unpredictable, not the patient’s fault, has the potential
Figure 1. Impressive asymptomatic hair loss over the top of the scalp, without inflammatory changes, and with normal follicular markings.
Figure 2. Impressive white regrowth shown 3 months after the Figure 1 was taken.
1
Department of Dermatology, University of California San Francisco, San Francisco, California, USA
Correspondence: Vera H. Price, Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, Suite 420, San Francisco, California 94143, USA. E-mail: [email protected]
& 2013 The Society for Investigative Dermatology
www.jidonline.org
S65
VH Price A Single Question Can Make the Diagnosis
for complete regrowth with or without treatment, and also may recur, and the patient has no control. It occurs in the healthiest patients. Alopecia areata is among the most prevalent autoimmune diseases (Gilhar et al., 2007). The target of the autoimmune attack in many cases is the melanocyte, and as a result, pigmented hair from pigmented follicles is often preferentially lost, and white or graying follicles are relatively spared (Shapiro, 2002). Regrowing hair shafts are often white as in this patient (Figure 2), before they become repigmented.
S66
CONFLICT OF INTEREST The author states no conflict of interest.
ACKNOWLEDGMENTS Funding for the Summit and publication of this article was provided by the National Alopecia Areata Foundation.
REFERENCES Gilhar A, Paus R, Kalish RS (2007) Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest 117:2019–27 Shapiro J (2002) Hair Loss: Principles of Diagnosis and Management of Alopecia. Martin Dunitz, pp 37–8
Journal of Investigative Dermatology Symposium Proceedings (2013), Volume 16
A Single Question Can Make the Diagnosis Vera H. Price1 Alopecia areata is the only condition that can cause complete hair loss in 3 months without symptoms or signs. Journal of Investigative Dermatology Symposium Proceedings (2013) 16, S65–S66; doi:10.1038/jidsymp.2013.27
PRESENTATION A 58-year-old woman presented with asymptomatic, impressive hair loss over the entire top of her scalp. Figure 1.
INVESTIGATIONS The single question that was the key to diagnosis: ‘‘How long have you had this?’’ Her response: ‘‘Three months.’’ CBC (complete blood count), TSH (thyroid-stimulating hormone), ferritin, and vitamin D25OH were normal. MANAGEMENT The presence of follicular markings ruled out a scarring alopecia. Alopecia areata is the only condition that can cause complete hair loss in 3 months without symptoms or signs. No treatment was given and she was asked to return for follow-up in 3 months.
HISTORY Before the dramatic loss she had a full head of hair. There was no history of patchy hair loss, atopy, thyroid problems, or vitiligo.
OUTCOME Three months later, she had impressive white hair regrowth. Figure 2.
EXAMINATION Almost total loss of hair over the top of her scalp. Follicular markings were present and appeared normal. There was no inflammation or scaling. She had no other areas of hair loss.
DISCUSSION Alopecia areata is usually easy to diagnose, but visits are time consuming because of the variables that the patient needs to know for a long-term view of the condition: it is highly unpredictable, not the patient’s fault, has the potential
Figure 1. Impressive asymptomatic hair loss over the top of the scalp, without inflammatory changes, and with normal follicular markings.
Figure 2. Impressive white regrowth shown 3 months after the Figure 1 was taken.
1
Department of Dermatology, University of California San Francisco, San Francisco, California, USA
Correspondence: Vera H. Price, Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, Suite 420, San Francisco, California 94143, USA. E-mail: [email protected]
& 2013 The Society for Investigative Dermatology
www.jidonline.org
S65
VH Price A Single Question Can Make the Diagnosis
for complete regrowth with or without treatment, and also may recur, and the patient has no control. It occurs in the healthiest patients. Alopecia areata is among the most prevalent autoimmune diseases (Gilhar et al., 2007). The target of the autoimmune attack in many cases is the melanocyte, and as a result, pigmented hair from pigmented follicles is often preferentially lost, and white or graying follicles are relatively spared (Shapiro, 2002). Regrowing hair shafts are often white as in this patient (Figure 2), before they become repigmented.
S66
CONFLICT OF INTEREST The author states no conflict of interest.
ACKNOWLEDGMENTS Funding for the Summit and publication of this article was provided by the National Alopecia Areata Foundation.
REFERENCES Gilhar A, Paus R, Kalish RS (2007) Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest 117:2019–27 Shapiro J (2002) Hair Loss: Principles of Diagnosis and Management of Alopecia. Martin Dunitz, pp 37–8
Journal of Investigative Dermatology Symposium Proceedings (2013), Volume 16