Differential diagnoses: Alopecia

Dr Nigel Stollery compares similar presentations and offers clues for their diagnosis, including alopecia areata, pseudopelad, male pattern baldness and lichen planopilaris

Alopecia areata

Presentation

  • Most common in teenagers
  • Males and females equally affected, but develops later in life in females
  • Typically, one or more patches develop, usually on scalp
  • Usually regular or round areas of loss with normal-looking skin
  • Occasionally, skin may be red, with fine scale and mild itch

Management

  • Diagnosis usually clinical
  • Managed in primary care
  • If in doubt, a biopsy can be taken
  • If less than half scalp affected, 80% recover without treatment
  • Treatment includes topical steroids, steroid injections, minoxidil and topical immunotherapy

Pseudopelad

Presentation

  • Cicatricial alopecia
  • Scarring alopecia with abnormal-looking skin in affected areas
  • Irregular areas of hair loss
  • Discrete areas of hair loss, most commonly on parietal scalp
  • Typically, worsens then improves in cycles
  • Can affect non-scalp hair, but very rarely

Management

  • Diagnosis of exclusion
  • Biopsy usually undertaken to look for other causes
  • Urgent referral may be needed
  • Treatment includes topical and intralesional steroids, with or without topical tacrolimus
  • Hydroxychloroquine with or without oral prednisolone can be helpful in severe cases

Male pattern baldness

Presentation

  • Most common cause of hair loss in men
  • Affects >50% of men by the age of 50 years
  • Typically, temples and crown affected first
  • Progressive condition
  • Genetic component, usually with familial history
  • Hair follicles present, but much smaller than normal
  • Underlying skin looks normal

Management

  • Minoxidil and finasteride may help, but improvement lost after stopping treatment
  • Surgical treatment not available on the NHS

Lichen planopilaris

Presentation

  • Scarring alopecia mainly affecting scalp
  • Rare inflammatory disorder
  • Cause unknown
  • Usually affects young women
  • Commonly associated with lichen planus in other areas
  • Smooth white skin with no visible follicles

Management

  • Refer to secondary care
  • Treatment includes topical and intralesional steroids, topical tacrolimus
  • Oral treatment includes hydroxychloroquine, tetracycline, acitretin, griseofulvin and mycophenolate
  • Response very variable
  • Dr Stollery is a GP in Kibworth, Leicestershire

Click here to take a test on this article and claim a certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GP dilemma: What should I do if a parent sends their child with COVID-19 symptoms to school?

GP dilemma: What should I do if a parent sends their child with COVID-19 symptoms to school?

Medical Protection's Dr Clare Devlin offers advice on how GPs should respond to parents...

GPs risk missing out on vital COVID-19 risk assessments, BMA warns

GPs risk missing out on vital COVID-19 risk assessments, BMA warns

GPs risk missing out on COVID-19 risk assessments unless practices are guaranteed...

GPs call for partial suspension of network DES amid heavy workload

GPs call for partial suspension of network DES amid heavy workload

GPs leading primary care networks (PCNs) have called for the partial suspension of...

UK COVID-19 alert level raised as GPs prioritised for testing

UK COVID-19 alert level raised as GPs prioritised for testing

The government has raised the UK's COVID-19 alert level to four amid reports that...

UK on course for 50,000 COVID-19 cases a day by mid-October

UK on course for 50,000 COVID-19 cases a day by mid-October

The UK could see 50,000 COVID-19 cases per day by mid-October, with the epidemic...

Stricter short-term COVID-19 measures needed to avoid second national lockdown, BMA warns

Stricter short-term COVID-19 measures needed to avoid second national lockdown, BMA warns

COVID-19 infection rates will ‘soar’ and the NHS will ‘once again be crippled’ if...