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ANSWER
The correct answer is that new hairs growing in to replace those lost from alopecia areata tend to be white (choice “b”). They usually regain their normal color, eventually.
DISCUSSION
Alopecia areata is an autoimmune phenomenon implying an increased tendency to develop other autoimmune diseases (eg, vitiligo [choice “a”], which can appear initially in the scalp).
This case turned out to be simple but had the potential to be far more serious. The biopsy of the dark patch showed benign seborrheic keratosis, but it was possible that another section could have demonstrated features of melanoma (choice “c”). When present, melanoma can occasionally trigger an immune response that destroys pigment cells in hair follicles, causing the hairs to lose their pigment. This is why the entire dark patch was later excised. Fortunately, the pathology report ruled out melanoma.
While it has been reported that stress can cause hair to turn gray (choice “d”), there were better (and more accurate) explanations for this patient’s presentation.
This case, though fairly straightforward, serves as a reminder that it is our job as clinicians to connect the dots to rule out worst-case scenarios.
Outcome
This patient’s hair all grew back, regaining its normal color, without any treatment.
ANSWER
The correct answer is that new hairs growing in to replace those lost from alopecia areata tend to be white (choice “b”). They usually regain their normal color, eventually.
DISCUSSION
Alopecia areata is an autoimmune phenomenon implying an increased tendency to develop other autoimmune diseases (eg, vitiligo [choice “a”], which can appear initially in the scalp).
This case turned out to be simple but had the potential to be far more serious. The biopsy of the dark patch showed benign seborrheic keratosis, but it was possible that another section could have demonstrated features of melanoma (choice “c”). When present, melanoma can occasionally trigger an immune response that destroys pigment cells in hair follicles, causing the hairs to lose their pigment. This is why the entire dark patch was later excised. Fortunately, the pathology report ruled out melanoma.
While it has been reported that stress can cause hair to turn gray (choice “d”), there were better (and more accurate) explanations for this patient’s presentation.
This case, though fairly straightforward, serves as a reminder that it is our job as clinicians to connect the dots to rule out worst-case scenarios.
Outcome
This patient’s hair all grew back, regaining its normal color, without any treatment.
ANSWER
The correct answer is that new hairs growing in to replace those lost from alopecia areata tend to be white (choice “b”). They usually regain their normal color, eventually.
DISCUSSION
Alopecia areata is an autoimmune phenomenon implying an increased tendency to develop other autoimmune diseases (eg, vitiligo [choice “a”], which can appear initially in the scalp).
This case turned out to be simple but had the potential to be far more serious. The biopsy of the dark patch showed benign seborrheic keratosis, but it was possible that another section could have demonstrated features of melanoma (choice “c”). When present, melanoma can occasionally trigger an immune response that destroys pigment cells in hair follicles, causing the hairs to lose their pigment. This is why the entire dark patch was later excised. Fortunately, the pathology report ruled out melanoma.
While it has been reported that stress can cause hair to turn gray (choice “d”), there were better (and more accurate) explanations for this patient’s presentation.
This case, though fairly straightforward, serves as a reminder that it is our job as clinicians to connect the dots to rule out worst-case scenarios.
Outcome
This patient’s hair all grew back, regaining its normal color, without any treatment.
About 2 months ago, a 55-year-old man suddenly experienced complete hair loss in 1 confined area of his scalp. There were no accompanying symptoms. Some of the hair subsequently grew back, but it was partially gray—a phenomenon that greatly disturbed the patient.
In general, the patient’s health was quite good, although he reported that the initial hair loss occurred about 1 month after he lost his job and got divorced.
Most of the hair was missing from a roughly round, 5-cm, ill-defined area of the left parietal scalp. The few hairs left were gray. More disturbing, though, was a dark (brown, tan, and black), oddly shaped, 2.8-cm patch in the center of the alopecic area.
Punch biopsy from the bald area showed clear evidence of alopecia areata (T-cells surrounding hair follicles, and lack of features that would support other items in the differential). Shave biopsy of the dark patch showed seborrheic keratosis, with no atypia.
