Case history
Case history
A 20-year-old woman presents with a 1-month history of patchy hair loss. The patient denies any symptoms of scalp itching or irritation. Past medical history is significant for mild asthma and eczema. Her aunt has rheumatoid arthritis. On physical examination, she has a circular area of hair loss measuring approximately 25 mm in diameter in the occipital scalp. The scalp in that area is slightly salmon-colored. The follicular orifices are intact and there is evidence of exclamation point hairs (short, broken hairs). A hair pull test is positive at the periphery of the alopecia patches (a sign of activity). [Figure caption and citation for the preceding image starts]: Hair pull testProvided by Paradi Mirmirani, MD [Citation ends].
Her brows and lashes appear normal, but her fingernails have evidence of fine ridges.
Other presentations
Loss of facial and/or body hair (including brows, lashes, or beard) is less common. Less common presentations are complete scalp hair loss with (alopecia universalis) or without (alopecia totalis) body hair loss. Diffuse hair loss is a rare presentation of alopecia areata.
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