Endgames Picture Quiz

Sudden onset hair loss and colour change

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6112 (Published 31 October 2013) Cite this as: BMJ 2013;347:f6112
  1. R C Lamb, specialty trainee year 6 dermatology registrar1,
  2. M Porter, consultant dermatologist1
  1. 1Alan Lyell Centre for Dermatology, Western Infirmary, Glasgow, G11 6NT, UK
  1. Correspondence to: R C Lamb rlamb{at}nhs.net

A 56 year old man presented with a history of rapid onset hair thinning over one month. He also noted a reduced need to shave his facial hair. In addition, he felt that the colour of his hair had changed from dark brown with “an occasional grey” to white. Specifically, he described attending a Christmas party with “normal” hair yet by Christmas Day his hair and beard were white.

There was no loss of body hair elsewhere. The hair loss was noted on brushing and in the shower basin. He denied scalp itch, scale, or rash elsewhere. He had no history of serious illnesses or stresses over the past year. His medical history included hypertension for which he took longstanding atenolol and ramipril. Both his parents had good heads of hair in old age and there was no family history of autoimmune conditions. Examination found white hair with a remaining band of pigmented hair at the occiput (figure). He had diffuse thinning of the hair and his beard was sparse, but there was no patchy hair loss, scale, erythema, or scarring. Blood samples were obtained and punch biopsies of the scalp showed an increased proportion of follicles in catagen or telogen phase, accompanied by a peribulbar lymphocytic infiltrate with no evidence of scarring.

Photographs showing evidence of hair thinning and white hair, with a band of pigmented hair remaining only at the posterior scalp

Questions

  • 1 What is the differential diagnosis?

  • 2 What investigations should be performed in patients with hair loss?

  • 3 How can the change in hair colour be explained?

  • 4 What treatments can be offered for this condition?

Questions

1 What is the differential diagnosis?

Short answer

Hair loss can be caused by hair cycle disorders, inflammatory conditions that damage the follicle, or inherited and acquired disorders of the hair shaft. The differential diagnosis for acquired …

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