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Arch Dis Child Educ Pract Ed 98:120 doi:10.1136/archdischild-2012-303256a
  • Dermatophile

Answers to Dermatophile questions

  1. Kachiu C Lee3
  1. 1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  2. 2Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  3. 3Department of Dermatology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Peter A Lio, 1455 North Milwaukee Avenue, 2nd Floor, Chicago, IL 60622, USA; p-lio{at}northwestern.edu
  • Received 23 October 2012
  • Accepted 30 January 2013
  • Published Online First 28 February 2013

From questions on page 106.

ANSWER TO Question 1

The answer is (D), kerion. This is a manifestation of tinea capitis, ringworm of the scalp. It can occur in more severe cases and in the very young, resulting in a boggy mass on the scalp with loss of hair. Diagnosis can be difficult as potassium hydroxide preparations can be negative in the presence of such inflammation; culture is frequently needed to prove scalp infection. Treatment must be in the form of an oral antifungal drug  indicated for tinea capitis for sufficient duration. Use of a topical antifungal shampoo is recommended concurrently to decrease spread of the disease.1

ANSWER TO Question 2

The answer is (A), alopecia areata. Alopecia areata is a common, usually patchy and often unpredictable hair loss on the scalp and the body, thought to be primarily an autoimmune disease. Although not a scarring form of alopecia, severe cases can last for years and may result in permanent hair loss. Exclamation point hairs are diagnostic (see figure 4), and pitting of the nails may also be seen (see figure 5).1 Treatment ranges from watchful waiting, as many cases are self-resolving within months, to topical and intralesional steroids, to using skin sensitisation to create a skin allergy that may help ‘reset’ the aberrant immune response. There is a significant association with autoimmune thyroid disease in these patients, so surveillance may be advised.2

Figure 4

Close up of patch revealing ‘exclamation point’ hairs (original magnification × 10). (Reprinted with permission from Lio PA. What’s missing from this picture? An approach to alopecia in children. Arch Dis Child Educ Pract Ed 2007;92:193–8).

Figure 5

Regular ridging and pitting of the nail plate in alopecia areata. (Reprinted with permission from Lio PA. What’s missing from this picture? An approach to alopecia in children. Arch Dis Child Educ Pract Ed 2007;92:193–8).

ANSWER TO Question 3

The answer is (C), transient neonatal hair loss. Transient neonatal hair loss is a physiological type of hair loss that can appear in the first weeks to several months of life, often with an oval-shaped prominence on the occipital scalp.3 It is thought to be accentuated by pillows and blankets placed under the head and neck but not directly caused by this friction. It is very common and requires no treatment as it self-resolves within the first year of life.

Footnotes

  • Contributors KCL is involved in drafting the manuscript, and PAL revised and supervised the manuscript.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

References

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