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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 927 - 10th January Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M65. Alopecia

Case posted by Dr. Richard Carr.



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Eman El-Nabarawy

Posted

If the third image from the left shows a cut sinus tract, so I will like to add dissecting cellulitis of the scalp to folliculitis decalvans. Special stains and cultures are needed to exclude bacterial and fungal infection

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Guest Maria George

Posted

I can see eosinophils , so I wish to add HIV-associated eosinophilic folliculitis and erosive pustular folliculitis to the above dfferetial.

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Sasi Attili

Posted

agree folliculitis decalvans likely. CPC and stains/ culture might be required to exclude Dissecting Cellulitis

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Robledo F. Rocha

Posted

Neutrophilic scarring alopecia without extensive dermal and subcutaneous abscess nor draining sinus tracts. Folliculitis decalvans is my favorite hypothesis.
I'd like to see Gram and PAS pictures.
[url="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2559.2009.03439.x/pdf"]http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2559.2009.03439.x/pdf[/url]

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Guest Tiberiu Tebeica

Posted

folliculitis decalvans with hair tufts

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Dr. Richard Carr

Posted

Just to orientate you image three (second on the left) is the most superficial level of the horizontally orientated biopsy (the deeper part of which is seen in image two on the upper right). There was no deep suppuration or dissecting process.

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Eman El-Nabarawy

Posted

As there is no deep suppuration or dissecting process so folliculitis decalvans will be favored..

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Guest Jim Davie MD

Posted

Folliculitis decalvans.
Scarring alopecia with distortion of follicular architecture (polytrichia/tufting, eccentric atrophy, and follicular destruction with hair granulomas), infundibular cyst formation, and a mixed inflammatory infiltrate with neutrophils, eosinophils, and plasma cells in fibrotic scarred dermis. Clinical pattern (and dark hairs suggestive of African descent) would be supportive. The hair shafts seem free of dermatophyte infection, but stains are needed to be sure.

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Eman El-Nabarawy

Posted

Negative stains favor folliculitis decalvans.

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Agree, neutrophilic scarring alopecia, Folliculitis decalvans.

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Dr. Richard Carr

Posted

Yes folliculitis decalvans was also my interpretation and this was also the clinical diagnosis but I did not want to make it too easy for you all. Many thanks for excellent contributions again.
Enjoy your weekends.

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