Case Number : Case 532 Posted By: Guest

[b]Richard Carr - Warwick (UK) Wrote:[/b]

I hope you all enjoyed this case! I must credit my close colleague, Dr Saleem Taibjee, for sharing this case with me. Dr Taibjee's report was as follows: Horizontal sections of this scalp biopsy indicate normal hair density. There is marked increase in percentage of catagen and telogen follicles in relation to anagen, with corresponding conspicuously increased fibrous stellae tracts at the deeper levels. In many instances the matrical epithelium appears disorganised with vacuolisation also noted,and focal pigment in the follicular epithelium is another indication of degenerative follicles. Although inflammation is generally sparse, CD3 staining does confirm residual inflammation in fibrous stellae. More superficial levels indicate small nanogen-like hairs with markedly thinned matrix and disorganised or absent hair shaft production. The features are in keeping with a subacute stage of alopecia areata. There is no evidence of scarring alopecia. In the spirit of learning (for us all) I forwarded additional images to Dr Restrepo who kindly comments as follows: Dear Dr Carr With the additional history and pics from the attached powerpoint presentation there is no doubt that the correct diagnosis is alopecia areata. Images 6, and 8 shows an early nanogen hair and a residual hair bulb with lymphocytic infiltrate. Sometimes it is very difficult to do the differential diagnosis between AA and trichotillomania. I went with the first one because I did not see an excess of miniaturized hairs. Thank you for sending me additional information on the case.

[size=2]Submitted on 23/06/2012 07:05[/size]
[b]Luis Fernando Cardenas Cardona - Centro Dermatologico de Cali (Cali,Colombia) Wrote:[/b]

Trichotillomania.

[size=2]Submitted on 23/06/2012 06:35[/size]
[b]Cirino - Brazil (Rio de Janeiro) Wrote:[/b]

Chronic traction alopecia

[size=2]Submitted on 22/06/2012 21:00[/size]
[b]Eman El-Nabarawy - (Egypt) Wrote:[/b]

Alopecia areata.

[size=2]Submitted on 22/06/2012 19:07[/size]
[b]Hazem Hamed - Imperial College (London) Wrote:[/b]

I am very late today and as most of you do not like alopecia very much. I think it in keeping with traction alopecia.

[size=2]Submitted on 22/06/2012 18:39[/size]
[b]Wilber J. Martínez C. - CES University (Medellín) Wrote:[/b]

Trichotillomania

[size=2]Submitted on 22/06/2012 17:02[/size]
[b]Marie MD - () Wrote:[/b]

Non scarring alopecia with mild lymphocytic infiltrate at base of the follicules= alopecia areata.

[size=2]Submitted on 22/06/2012 15:00[/size]
[b]Rebecca Shanesmith - Tulane University (New Orleans, LA) Wrote:[/b]

Dr. McKee, Thank you for this site. I am using it as one of the ways to study for my dermatopathology boards in September. I am of course also reading your book again which I have found very enjoyable.

[size=2]Submitted on 22/06/2012 14:59[/size]
[b]Richard Carr - Warwick (UK) Wrote:[/b]

Enormous thanks to Sarah Roberts (SpR Histopathology) who has provided me additional information. The woman had two rounded patches of hair loss either side of the posterior scalp and had noticed the hair coming out on combining. There was no itching or soreness. She had been using hair dye for 2 years and was also tying her hair back. Clinically it was thought to be most like alopecia areata and there was a good response to triamcinolone injection and she was discharged from clinic.

[size=2]Submitted on 22/06/2012 14:26[/size]
[b]Marwa Fawzy - Dermatology Department, Faculty of Medicine, Cairo University () Wrote:[/b]

Mild infiltrate with some scarring around the hair follicles ,i think it is starting scarring alopecia.

[size=2]Submitted on 22/06/2012 13:24[/size]
[b]I. Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

My next guess would be androgenetic alopecia and, then, alopecia areata.

[size=2]Submitted on 22/06/2012 13:20[/size]
[b]Richard Carr - Wawrick (UK) Wrote:[/b]

I cannot pretend I am an expert in hair either but we did not diagnose Trichotilomania in this case. I think a lot of us are out of our comfort zone here!

[size=2]Submitted on 22/06/2012 12:58[/size]
[b]Mona Abdel Halim - () Wrote:[/b]

Trichotillomania

[size=2]Submitted on 22/06/2012 12:40[/size]
[b]Rodrigo Restrepo - UPB/CES (Mdlln/COL) Wrote:[/b]

Trichotillomania.

[size=2]Submitted on 22/06/2012 12:22[/size]
[b]Sasi Attili - Ninewells University Hospital, Dundee (United Kingdom) Wrote:[/b]

Hair is not something know a lot of, but I shall try. Overall there does seem to be a definite decrease in follicular density with numerous telogen and a catagen hair visible. Follicular degeneration and perifollicular lamellar fibrosis in pic on bottom left. Pigmented follicular stellae in bottom right. I don't think the number of vellous hairs per se is high though a vellous hair is shown in the bottom left pic. There is a sparse lymphocytic infiltrate and given the features above I think this is central centrifugal cicatricial alopecia. Pseudopalade of broque is obviously in the differential (whatever the entity is!)

[size=2]Submitted on 22/06/2012 11:33[/size]
[b]Giovanni Falconieri (Falco) - Dept Pathology (Udine, Italy) Wrote:[/b]

Hi everybody! I would favor trichotillomania though I have near-zero familiarity with the alopecia realm. Miniaturized follicle, uneven intrafollicular hemorrhage, melanin cast plus mild chronic inflammation would go along (as outlined by Catherine Stefanato in her excellent review, Histopathology 2010; 56:24-38). Happy to join this forum of outstanding colleagues. Greetings from hot northern Italy.

[size=2]Submitted on 22/06/2012 11:29[/size]
[b]Marcela Saeb Lima - INCMNSZ (Mexio City) Wrote:[/b]

traction alopecia which in older people can leave some scarring

[size=2]Submitted on 22/06/2012 11:22[/size]
[b]I. Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

Non-scarring alopecia. Absence of inflammation and presence of pigmentation (picture 4) makes me think of trichotillomania.

[size=2]Submitted on 22/06/2012 11:20[/size]