Patchy loss of hair on scalp

Q- A male patient presents with patchy loss of hair on scalp, eyebrows and beard. He also gives a history of rapid graying of hair in a few areas. The likely diagnosis is:

a. Alopecia areata
b. Anagen effluvium
c. Telogen Effluvium
d. Androgenic aplopecia

Correct answer: a

Single or multiple circumscribed smooth patchy hair loss, most obviously on scalp but frequently involving any hair bearing skin eg. beard, eyebrows, eye lashes, with pathognomic ” Exclamation mark” & “Going gray overnight” phenomenon (i.e., white or gray hairs are frequentely spared). indicate the diagnosis of Alopecia areata.

Features of Alopecia Areata

  • – Onset of Alopecia is sudden.
  • – Alopecia is well circumscribed and patchy (round or oval patches of baldness).
  • – Lesions usually situated on scalp (most common site).
  • – Lesions may involve beard of other hair bearing sites such as eyebrows or eyelashes.
  • – Skin within the areas of hair loss is normal.
  • – Non-inflammed, Non scarring Alopecia.
  • – Hair show the pathognomic ‘Exclamation mark’ sign.
  • – Believed to be an autoimmune condition.
  • – associated with other autoimmune diseases is seen.
  • – A positive family history may be obtained.
  • – Rapid onset graying of hair may be observed ‘going gray overnight’.
  • – The mechanism of rapid graying is thought to be the selective shedding of pigmented hair and retention of the non pigmented (already grey) hair.

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