Make the Diagnosis: Prom Nightmare



Case Findings: This healthy 16 year old girl was getting ready for prom, when she noticed her eyelashes were gone. She was already pretty stressed out, but this was making it worse.

499% Thyroid disease

2227% Alopecia areata

805% Telogen effluvium

2725% Trichtillomania


Alopecia areata is a T-lymphocyte mediated autoimmune disease of the hair follicle resulting in nonscarring hair loss. Most cases are limited to 1 or 2 small patches of alopecia, but in severe cases all the hair on the scalp is lost (alopecia totalis) or all body hair is lost (alopecia universalis). Hair in most patients will spontaneously regrow, though recurrences are common. Alopecia areata is seen equally in both sexes and in patients of all ages and ethnicities. It may be seasonal. There is an increased incidence of alopecia areata in patients with Down syndrome, lichen planus, and other autoimmune diseases such as vitiligo, lupus erythematosus, rheumatoid arthritis, pernicious anemia, or thyroid disease. The most frequent association is with thyroid disease. Patients with alopecia areata are also more likely to have atopy, and its presence is felt to be a poor prognostic indicator for alopecia areata. The condition is treatable but cannot be cured.

What To Look For:
The course of alopecia areata is unpredictable, with wide variation in duration and extent of disease occurring from patient to patient. Round, patchy areas of nonscarring hair loss. Although it usually affects the scalp, the condition can also target the eyebrows, eyelashes, beard, and other body sites. Additionally, pitting and ridging of the fingernails can occur with this disease. Hairs that grow back are often hypopigmented, temporarily or permanently. This hypopigmentation is not seen in other forms of alopecia.

Often when there is a regrowth after diffuse loss, a patch of alopecia also along the inferior hairline from ear to ear remains, and this is temporal ophiasis pattern.

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