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 appropriate treatment for this condition?

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 appropriate treatment for this condition?

Quizplus · Accepted Answer

Explanation: Topical or intralesional corticosteroids are the treatment of choice for patients with alopecia areata. Patient education and information is also the key part of treatment. Patients should be made aware that: (1) the disease is usually benign, (2) they can have multiple relapses in spite of treatment, and (3) most patients have normal hair growth within the next one to two years even without treatment. They should also be informed that treatment with steroids, either intralesional or topical, can restore normal hair growth but does not cure the disease. After a steroid injection, new hair growth is usually seen in the next four to six weeks. (Choice A)There is no indication for the use of topical antifungal agents in this patient. (Choice B) A single intramuscular injection of penicillin G is useful in the treatment of patients with secondary syphilis. Antibiotics have no role in the treatment of alopecia areata. (Choice D)Alopecia areata is a chronic and relapsing disease. The risk of use of long-term oral corticosteroids outweighs the potential benefits in the patients. (Choice E) Topical tacrolimus is a calcineurin inhibitor. It is a useful alternative to topical corticosteroids in the treatment of inflammatory skin disorders such as atopic dermatitis. It has no role in the treatment of alopecia areata. Educational Objective: Topical or intralesional corticosteroids are the preferred first-line treatment in patients with alopecia areata.

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