September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 27-year old man presented with a six-week history of hair loss affecting the scalp. There was no itch or pain.
There was no personal or family history of hair or skin problems. The patient was otherwise well and took no medications.
Examination revealed a non-scarring alopecia. There was no scale or erythema. Close inspection revealed the presence of 'exclamation mark' hairs (short, broken hairs). There was also pitting of the nails.
What is the diagnosis?
The diagnosis is alopecia areata.
Alopecia areata (AA) is a chronic inflammatory disease that affects the hair follicle causing patchy non-scarring hair loss on the scalp. Total loss of scalp hair is known as alopecia totalis, and loss of the entire scalp and body hair is known as alopecia universalis.
Alopecia areata is probably an autoimmune disorder and about 20% of patients have a family history.
The characteristic initial lesion is a circumscribed, totally bald, smooth patch. The skin within the bald patch is normal or slightly reddened. There is no scarring. Short broken hairs (exclamation mark hairs) are often seen around the margins of active expanding patches of alopecia. Yellow dots can be seen around hair follicles.
Other hair-bearing areas of skin such as the beard can be affected. In some patients the eyebrows and eyelashes may be the only affected sites.
Subsequent progress is very varied; the initial patch may regrow within a few months, or further patches may appear after an interval of three to six weeks and then in a cyclical fashion. Sometimes a succession of discrete patches become confluent leading to a diffuse loss of hair. Occasionally patients go on to lose all / almost all of their scalp hair (alopecia totalis) or their entire scalp and body hair (alopecia universalis).
Nails are involved in 10% of patients referred for specialist advice, usually in the context of severe hair loss. Nail pitting is the most common finding, but some cases show a roughening of the nail plate or non-specific dystrophic changes.
Please follow this link to read more about AA, including its management.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
The following pharmaceutical companies have had no involvement in the content of this website or in our conference programmes
