Case 3
Mon, 04/12/2010 - 10:14 — Stephen Lyle, M.D., Ph.D.
Contributor(s):
23 year old female with hair loss, Rule out discoid lupus, lichen planopilaris, etc.
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Diagnosis:
Non-scarring alopecia most consistent with alopecia areata
This case represents a challenge due to inadequate sampling without subcutaneous tissue and deeper follicles.
Level 1 starts in the mid dermis and shows increased telogen follicles with a suggestion of inflammation near one hair bulb. No fibrosis or follicular dropout is seen.
Level 2 moves higher in the dermis and shows no significant inflammation of follicular epithelium. Additional telogen follicles are seen. In total 13 of 25 follicles are in telogen phase.
Level 3 contains upper follicles and epidermis. No epidermal changes are seen. There is no interface changes of lupus and no lichenoid changes of LPP. At least 10 follicles are vellus-sized.
A call to the clinician indicated a focal lesion of hair loss and inflamed scalp of parietal scalp. The features along with the clinical description are most consistent with alopecia areata, which can show increased telogen hairs and vellus-sized follicles.
If the pattern was more diffuse, the changes would suggest telogen effluvium or early androgenetic alopecia.