Alopecia
1. The Clinical Decision Tree
Non-Scarring (Reversible)
The Clue: Follicular openings are visible. No skin atrophy or shiny appearance.
- Alopecia Areata (Smooth patches)
- Androgenetic Alopecia (Pattern)
- Telogen Effluvium (Stress/Post-partum)
- Tinea Capitis (Simple fungal)
Scarring (Permanent)
The Clue: Loss of follicular openings. Skin looks shiny, smooth, or atrophied.
- Kerion (Inflammatory fungal)
- Discoid Lupus (DLE)
- Lichen Planopilaris
- Severe Burns/Trauma
2. High Alert: Kerion
Kerion: An intense immune reaction to fungal infection. It is the most common cause of scarring alopecia in children if not treated rapidly.
The Clue:
A painful, boggy (spongy) inflammatory mass. Features include pustules, thick crusting, and easily plucked hairs. Mistaking this for a bacterial abscess is common.
3. Management
General Alopecia Management:
- Depends on the causes: Infections, deficiency, drugs, inflammation.
For Kerion (To Prevent Scarring):
- Griseofulvin: 500mg BD for 6-8 weeks.
- Prednisolone: 1mg/kg/day for 1 week to dampen the scarring inflammatory response.
- AVOID I&D: Incision and drainage will worsen scarring.
⚠️ Clinical Pearl: The "Hair Pull Test." Gently pull a group of ~50 hairs. If >10% (more than 5-6 hairs) come out easily, it indicates an active phase of hair loss (Effluvium or active Areata).
📸 Images