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Rapid response of topical minoxidil in congenital triangular alopecia

Dear Editor, A 16-year-old boy presented with a bald patch over left frontotemporal scalp since childhood (Figure 1a) with no history of prior trauma, scaling or hair growth in the patch. On examination, there was a triangular shaped 4.5 × 2.5 cm, non-cicatricial alopecia patch with fine vellus hair in the center and follicular openings on dermoscopy (Figure 1b). A diagnosis of congenital triangular alopecia (CTA) was considered. Patient was counseled and was prescribed 5% minoxidil lotion over the alopecia patch twice daily. Patient had growth of terminal hair in the center of the lesion (Figure 2a) after 4 weeks of the follow-up period. CTA is a non-scarring alopecia that is characterized by stable and asymptomatic alopecic patches. It is also known as “Brauer nevus” and was first described by Sabouraud in 1905. It mostly appears at birth or during the first 9 years of life. The pathogenesis of CTA is still unknown, but it has been proposed that localized follicular miniaturization could contribute to its development. Trakimas et al suggested a rationale for minoxidil in CTA, as it can prevent the localized process of hair miniaturization. In our patient, terminal hair growth was observed in 1 month with minoxidil treatment and trichoscopy revealed growth of terminal hair (Figure 2b).