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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 2636 - 13 August 2020 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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74F, Alopecia. (No other clinical info provided).

Edited by Admin_Dermpath


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Richard Logan

Posted

Non-inflammatory hair loss with distorted follicles and some haemorrhage.  I would go for traction alopecia or trichotillomania, although the latter diagnosis is less common in this age group.

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Richard Logan

Posted

PAS has now been posted showing fungal spores at the osteum and PAS +ve debris.  It would be interesting to see the PAS appearance deeper down in the follicles, but the distortion of the hair shafts suggests an endothrix infection, most likely T. tonsurans.  The lack of inflammation also fits.

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Saleem Taibjee

Posted

Hi. Of course, one difficulty is reporting such cases in the absence of full clinical information. My interpretation was that the fungal/yeast spores evident within the follicular ostia are incidental (red herrings). These did not extend deeper within the follicles, and we not infrequently encounter these colonisers in biopsies on the head and neck.

For me the distorted and twisted follicles, which were only evident in some of the levels (emphasizing the need to examine multiple levels in alopecia cases), are pathognomonic of traction alopecia (or trichotillomania). Hence I suggested this possibility even in the absence of adequate clinical information, but advising clinical correlation.

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