A 25-year-old African-American medical student comes to see you in the office. His girlfriend noticed an area of circular hair loss over the back of his head. He is concerned that he is losing his hair and will be bald soon. He is otherwise in good health and denies any history of smoking, alcohol, or illicit drug use. He has had a monogamous relationship with his girlfriend for the past three years. On examination, there is a 1 cm area of complete, smooth and circular hair loss with distinct margins. There is no scaling or inflammation present in or around the area of hair loss.
Which of the following is the most likely cause of the above findings?

Question

A 25-year-old African-American medical student comes to see you in the office.  His girlfriend noticed an area of circular hair loss over the back of his head.  He is concerned that he is losing his hair and will be bald soon.  He is otherwise in good health and denies any history of smoking, alcohol, or illicit drug use.  He has had a monogamous relationship with his girlfriend for the past three years.  On examination, there is a 1 cm area of complete, smooth and circular hair loss with distinct margins.  There is no scaling or inflammation present in or around the area of hair loss.
Which of the following is the most likely cause of the above findings?

Quizplus · Accepted Answer

Explanation: Hair loss is a common problem that can have severe psychological effects in younger patients. The patient in the above vignette appears to be suffering from alopecia areata. It is a relatively common disease and is characterized by discrete, smooth and circular areas of hair loss over the scalp. There is typically no associated scaling or inflammation present in the area of hair loss. The hair loss usually develops over a few weeks and has a recurring pattern. Most of the patients will have regrowth of the hair in the involved areas over time. (Choice A)Patients with tinea capitis have an associated scaling and inflammation of the scalp in the areas of hair loss. (Choice B)Localized discoid lupus erythematosus of the scalp causes hair loss, scaling, inflammation, scarring, and hypopigmentation of the skin. There may be associated lesions present over the face or extremities. (Choice D)Areas of hair loss in secondary syphilis are not smooth and discrete. The lesions usually have a "moth-eaten" appearance and are associated with significant scarring. (Choice E)Hair loss in men with androgenetic alopecia starts in the frontal or temporal areas and progresses gradually (male pattern baldness). Educational Objective: Alopecia areata is characterized by smooth and discrete areas of complete hair loss. There is no associated scaling, scarring, or inflammation.

A 25-Year-Old African-American Medical Student Comes to See You in the Office