Alopecia

(Part 1)
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 Alopecia (Part 1)
• History and Physical Exam
• Alopecia areata
• Tinea capitis
Alopecia areata Tinea capitis

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 History
• Sudden vs. Gradual
• Focal vs. Diffuse
• Review of Systems
• Medications

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 Physical Exam
• 1. Scalp examination
• 2. Hair pull test
• 3. Tug test

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 Physical Exam
Is there evidence of inflammation?
• 1. Scalp examination
Is the distribution focal or diffuse?
• 2. Hair pull test
• 3. Tug test
Inflammation Focal Distribution Diffuse Distribution

CC (3.0) – Grook Da Oger CC (3.0) – Kevlaraz CC (3.0) – Pixababy

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 Physical Exam
• 1. Scalp examination
• 2. Hair pull test
• 3. Tug test
60 hairs ≥6 hairs

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 Physical Exam
• 1. Scalp examination
• 2. Hair pull test
• 3. Tug test
Hair

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 Alopecia Areata
• Presentation: Well-circumscribed, smooth areas of hair loss
• No erythema, scale, or inflammation
• Scalp most common

• Pathophysiology: Autoimmune

CC (3.0) – Thirunavukkarasye-Raveendran

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Alopecia Areata

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 Alopecia Areata
• Dx: Clinical
• +/- Positive hair pull test (vs. Trichotillomania)
• +/- TSH, T4
• Entire scalp => Alopecia totalis
• Entire body => Alopecia universalis

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 Alopecia Areata
• Dx: Exclamation point
hairs

CC 0 (1.0) – Who

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 Alopecia Areata
• Mgmt: Topical Clobetasol
• Intralesional Triamcinolone
• If >50% of scalp => Immunotherapy

CC (1.0) – Who

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 Tinea Capitis
• Presentation: Prepubertal child w/ patches of hair loss
• Erythema, scale, or pustules
• +/- “Black dot variant”
• +/- Pruritis Inflammation
• +/- Lymphadenopathy

CC (1.0) – CDC

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 Tinea Capitis
• Pathophysiology: Fungal
• Dermatophytes: Microsporum, Epidermophyton, Trichophyton
• ↑ risk if Diabetes, Immunosuppression

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Black Dot Variant

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Kerion

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Kerion

CC (3.0) – Grook Da Oger

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 Tinea Capitis
• Dx: Clinical
• KOH prep (1st test) => Hyphae
• Fungal Cx (Best test) Hyphae

CC (1.0) – CDC

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 Tinea Capitis
• Mgmt: Oral Antifungal
• Griseofulvin
• Terbinafine
• Azoles

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High-Yield Summary

Alopecia Tinea capitis Tinea capitis (Black

areata (Kerion) Dot)

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High-Yield Summary

Alopecia areata Tinea capitis

• Pres: No inflammation • Pres: Inflammation +/- Black dot
• Well-circumscribed areas • +/- Lymphadenopathy

• Path: Autoimmune • Path: Trichophyton

• Dx: Clinical • Dx: Clinical

• Exclamation point hairs • KOH, Fungal Cx

• Mgmt: Corticosteroids • Mgmt: Oral Antifungal

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