Presenter: Stacy Rosenblum, D.O, Amanda Beehler, D.O. Amy Spizuoco D.O. Mariel Bird, D.O.

Dermatology Program: LECOMT/Alta Dermatology

Program Director: Stephen Kessler, D.O.

Submitted on: February 3, 2011

CHIEF COMPLAINT:  “Bald spots on scalp”

CLINICAL HISTORY: A 32-year-old Caucasian male presented with a progressive, one-month history of hair loss in patches. He denied loss of hair anywhere else on his body or any other skin lesions. He was otherwise healthy and had no significant past medical history or history of major medical illness in his family.  He had been seen by his primary care physician and was using Nystatin once a day for 4-5 days with no improvement. He is married, and denied the use of tobacco or alcohol. Upon further questioning, the patient did admit to extramarital relations.

PHYSICAL EXAM:
On bilateral parietal, temporal, and occipital scalp there were multiple nummular patches of hair loss in a moth-eaten pattern (Figure 1). The areas of alopecia were free from erythema, scale, or other lesions. No other cutaneous lesions were identified on complete skin examination.

LABORATORY TESTS:

Rapid plasma reagin (RPR) with reflex titer: Reactive with a titer of 1:32.
Fluorescent treponemal antibody absorption (FTA-ABS): Reactive.

DERMATOHISTOPATHOLOGY:

Spongiotic dermatitis with chronic perifolliculitis and reactive changes. Periodic acid-Schiff (PAS) with diastase stain showed no microorganisms. Immunoperoxidase stains were negative for spirochetes.

DIFFERENTIAL DIAGNOSIS:

1.   Tinea Capitis
2.   Alopecia syphilitica
3.   Alopecia areata
4.   Alopecia neoplastica
5.   Trichotillomania