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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 970 - 12th March Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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11 year-old female with patches of alopecia.

Case posted by Dr. Hafeez Diwan.


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Dr. Mona Abdel-Halim

Posted

Melanin casts makes me favor trichotillomania.

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Guest Jim Davie MD

Posted

Agree with Mona's observation of melanin casts and absence of terminal hairs (at least, in these sections) supporting trichotillomania.

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Agree with Trichotillomania. Melanin casts are a good tip, also seen in other cases like a.areata, but the age is more compatible with Trichotillomania and figure 4 shows an empty follicular lumina. I was looking for dermal hemorrhage but did not see it.

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Robledo F. Rocha

Posted

A slight inflammatory non-scarring alopecia showing distorted hair follicles, some of them with loss of hair shafts, and some with trichomalacia, the last feature often absent in alopecia from hairs submitted to traction, namely traction alopecia, but commonly found in alopecia from hairs that have been twisted and pulled out, namely trichotillomania.
Detailed clinical data will inform if patient is an African descent girl who undergoes hair styling techniques and presents hair loss at the margins of the scalp, or if patient is a girl who suffers from emotional instability and presents bizarre-shaped patches of hair loss.

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John Zhang

Posted

Pigment casts without trichomalacia is not specific for trichotillomania, and can be seen in allopecia areata. Empty hair follicles without shafts can also be a not uncommon processing artifact. I think that the smaller hair follicles in pictures 2 and 4 may represent nanogen hairs. Therefore in this case although the differential diagnosis includes trichotellomania, I kind of favor allopecia areata, despite the lack of inflammation in one hair bulb (picture 3). A careful clinical examination and correlation might be further contributory.

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