3 year-old with poor hair growth

Presenter: Kate Chilek, DO
Dermatology Program: Ohio University/O’Bleness Memorial Hospital
Program Director: Scott Drew, DO & Mary Beth Luca, DO
Submitted on: Apr 28, 2010

CHIEF COMPLAINT:  3 year-old female presented for the evaluation of “poor hair growth.”

CLINICAL HISTORY:

Signs and symptoms:  Born with dark blonde scalp hair, which fell out by 3 months of age. She re-grew some hair, but it was never substantial. Otherwise healthy, with normal growth and development.

Previous Treatment:  None.

Other information:  Patient’s younger brother appears to have similar condition but has not been diagnosed. No known familial disorders. Parents are unrelated.

PHYSICAL EXAM:

Normal nails, dentition, eyebrows, and eyelashes. Involving much of the scalp are light blonde, vellus hairs. Some fine, follicularly distributed papules on the scalp.

 

Normal dentition.

 

 

Involving much of the scalp are light blonde, vellus hairs. Some fine, follicularly distributed papules on the scalp.

 

 

Note normal eyebrows and eyelashes.

LABORATORY TESTS:

Lead level, vitamin D level, and thyroid studies WNL. Direct microscopy of scalp hair revealed no structural or hair shaft abnormalities. Cytogenetics report revealed a normal female karyotype: 46,XX.

 

DERMATOHISTOPATHOLOGY:

Scalp biopsy was declined by parents due to the potential for psychological trauma to the patient. Replacement of mature hair follicle structures by follicular cysts filled with cornified material is characteristically seen on scalp histology.

DIFFERENTIAL DIAGNOSIS:

1.   Alopecia universalis
2.   Atrichia with papular lesions
3.   Alopecia totalis
4.   Vitamin-D-dependent rickets
5.   Alopecia areata


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