15 year old with hair loss since 3 months of age

Presenter: Kevin Svancara, DO, Jonathan Bellew, DO
Dermatology Program: Advanced Desert Dermatology (MWU)
Program Director: Vernon T. Mackey DO
Submitted on: Aug 24, 2016

CHIEF COMPLAINT:  Hair loss and thinning of the scalp

CLINICAL HISTORY:

Signs and symptoms:  15 year old female presents with diffuse hair loss and thinning of the scalp. Her hair loss is worse on the posterior scalp. She states her scalp is flaking, itching, and burning. Her symptoms have been present since she was three months old. She states her hair breaks very easily. She also reports small rough bumps on the backs of her arms and lateral legs that occasionally itch.

PMH: Bipolar Disorder
Medications: Depakote, Ketoconazole 2%shampoo
Family History: No significant family history. No family history of similar hair condition. Does not know her father or his family history
Social History: Student, non-smoker, no alcohol
Surgical History: None
Allergies: NKDA

Previous Treatment:  The patient had been treated for seborrhea for years with ketoconazole shampoo. She washes her hair twice daily. Some improvement noted in scale, but no improvement noted in hair loss or thinning.

Other information:  None

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:

None

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)


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