Presenter: Kevin Svancara, DO, Jonathan Bellew, DO
Dermatology Program: Advanced Desert Dermatology (MWU)
Program Director: Vernon T. Mackey DO
Submitted on: August 24, 2016
CHIEF COMPLAINT: Hair loss and thinning of the scalp
CLINICAL HISTORY: A 15-year-old female presents with diffuse hair loss and thinning of the scalp, with the most significant loss occurring on the posterior aspect. She reports that her scalp is flaking, itching, and burning, with these symptoms having persisted since she was three months old. The patient also notes that her hair breaks very easily. Additionally, she describes small, rough bumps on the backs of her arms and lateral legs that occasionally itch. Her past medical history includes bipolar disorder, and she is currently taking Depakote and using ketoconazole 2% shampoo. There is no significant family history, including any known family history of similar hair conditions, and she does not have information regarding her father’s family history. Socially, she is a student, does not smoke, and does not consume alcohol. She has no surgical history and no known drug allergies (NKDA). Previously, the patient has been treated for seborrhea with ketoconazole shampoo for several years, washing her hair twice daily. While some improvement in scalp scaling has been noted, there has been no improvement in hair loss or thinning.
PHYSICAL EXAM:
Large patches of thinning hair, worse on the occipital scalp. Positive hair pull test. Dermoscopy shows a beaded appearance of the hair shaft. Multiple monomorphic, less than 1mm, tiny follicular papules on the posterior arms.
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY:
Hair examination under light microscopy and dermoscopy shows a beaded appearance of the hair shaft
DIFFERENTIAL DIAGNOSIS:
1. Monilethrix
2. Pseudomonilethrix
3. Alopecia Areata
4. Pili Torti
5. Trichothiodystrophy (Tay Syndrome)
