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Case 156

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A nine year-old male child presents with hair loss for the past two weeks, that started abruptly. The family efers a similar presentation when he was six, but not as severe as now, successfully treated. Denies other signs and symptoms, family history of alopecia, autoimmune diseases or comorbidities. No psychological factors were related to the alopecia.

Based on the clinical picture and images, which of the following is the most likely diagnosis?

a) Tinea capitis

25%

b) Trichotillomania

25%

c) Alopecia areata

25%

d) Scarring alopecia

25%
   

Image analysis

Image 3: Scalp two weeks since the start of alopecia, evidencing multiple oval areas of hair loss, with no sings of inflammation of scalp atrophy. The scalp appears smooth and shiny.

 

Image 4: Scalp three weeks since the start of alopecia evidencing rapid progression of hair loss.

Relevant aspects

- The alopecia areata is a form of non-cicatricial alopecia, usually depicting a circular pattern.

- It is an autoimmune disease related to genetic and behavioral factors.

- The diagnosis is clinical, although biopsy may be considered in unusual cases.

- Signs of a poor prognosis are: beginning in childhood, positive family history, nails compromise and ophiasis pattern.

- Initial treatment includes topical corticosteroids.

- The psychological support is important due to the aesthetic and emotional impact of the disease.

References

- Bolognia LJ, Jorizzo LJ, Rapini PR. Dermatologia. 2ª Edição. Rio de Janeiro: Elsevier; 2009. 

- Sampaio SAP, Rivitti EA. Dermatologia.  3ª Edição. São Paulo: Artes Médicas; 2007.

- Messenger, GA. Management of alopecia areata. In UpTodate, 2014.

- Messenger, GA. Clinical manifestations and diagnosis of alopecia areata. In UpTodate, 2014.

Author

Janaína Chaves Lima, 6th year medical student at UFMG.

Email: janaina-chaves[at]hotmail.com

Supervisor

Antonio Guedes, dermatologista and professor at the UFMG School of Medicine.

Reviewers

Luanna Monteiro, Amanda de Oliveira, Ana Júlia Furbino, professora Viviane Parisotto

Translated by

Renato Gomes Campanati, 6th year medical student at UFMG. Email: campanati[at]ufmg.br.

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