Jump to content
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 1704 - 8 December - Dr Arti Bakshi Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

Clinical History: 6yr/F Area of alopecia on scalp for 1-2 years (vertex and temple), worse when stressed. ?traction alopecia ?Alopecia areata Case c/o Dr Rajeev Shukla.

Case Posted by Dr Arti Bakshi

Edited by Admin_Dermpath


  Report Record

User Feedback


Admin_Dermpath

Posted

Another great case to go with shiny new portrait of today's Case Poster Dr Arti Bakshi

 

Cheers, Geoff Cross - DermpathPRO Projects

Share this comment


Link to comment
share_externally

vincenzo polizzi

Posted

Alopecia is a tricky pathology chapter for me. Being to what I studied, this case looks like an alopecia aerata with overlapped trichotillomania...but sincerely I'm not sure... 

Share this comment


Link to comment
share_externally

Raul Perret

Posted

For me is quite a tricky chapter of dermpath Vincenzo, and to be honest Im not a fan of it either haha. I see catagen and telogen predominance, infundibular dilation, pigment casts  and distorted follicles. Absence of follicle miniaturization and apparently no hemorrhage or prominent inflammatory infiltrate (although I have my doubts in picture 8 lower right corner). This is a tricky differential, due to the absence of follicular miniaturization and inflammatory infiltrate and the presence distorted follicles I would tend to favour trichotillomania for CPC. 

Share this comment


Link to comment
share_externally

Dr. Mona Abdel-Halim

Posted

Trichotillomania is my favored diagnosis

Share this comment


Link to comment
share_externally

Nitin Khirwadkar

Posted

Catagen/telegen increase with Pigment casts. There is some peribulbar inflammation. Naturally, two differentials come to mind, chronic phase of alopecia areata ( will have marked catagen/telogen excess and miniatiaturised follicles) and trichotillomania. The latter can have some minimal inflammation. Would favour trichotilomania. CPC to r/o chronic AA.

Share this comment


Link to comment
share_externally

Dr. Richard Carr

Posted

Alopecia areata favoured. You can get pigment casts in AA.

Share this comment


Link to comment
share_externally

Arti Bakshi

Posted

Well done to all who favoured alopecia areata!

Ofcourse the main differential is a traumatic alopecia in view of prominent pigment casts and trichomalacia. But the clue to the correct diagnosis is in the (rather focal) peribulbar inflammation. I purposely did not zoom into in, but as Raul rightly observed it is present in image 8 (and also image 4). I have asked Geoff to put some high power images of these areas. Also, note that these bulbs are high up in the dermis, hence represent bulbs of miniaturised follicles. Remember, peribulbar inflammation can be focal and even absent in chronic forms of AA.  Clinically, the pattern was felt to be more in keeping with AA too. See link for a good article on changes other than peribulbar inflammation in AA.https://www.ncbi.nlm.nih.gov/pubmed/21684037

So, the main take home message is that traumatic alopecia can overlap histologically with AA. Whilst pigment casts, trichomalacia and increased telogen counts are common to both, peribulbar inflammation and miniaturisation are features not seen in traumatic alopecias.

@Vincenzo....you did pretty well, so maybe the alopecia chapter isn't so difficult after all!!

 

Share this comment


Link to comment
share_externally

Admin_Dermpath

Posted

Arti et al, I have just added the two extra images as requested.

Cheers, Geoff Cross - DermpathPRO Projects

Share this comment


Link to comment
share_externally

Raul Perret

Posted

Thank you and nice case Arti very instructive as always. Well done to the colleagues too

Share this comment


Link to comment
share_externally

Arash Daryakar

Posted

I just saw this beautiful case.

Thanks Arti!

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...