Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We would argue that no resources were wasted in this case Sir. Firstly the spontaneous resolution/improvement in this patient’s hair loss occurred after investigations were performed. Investigations were performed with a view to guide possible treatment. Were this patient’s symptoms caused, for example, by telogen effluvium, other than correcting reversible causes such as low ferritin we would have had little to offer with respect to treatments. However as the histology was entirely in keeping with alopecia areata we would have been in a position to offer this gentleman several treatments including treatment with diphencyprone acetate, through our dedicated hair clinic in Greater Glasgow and Clyde. Additionally as alopecia areata is often a chronic condition, and rarely with such rapid resolution as in this case, it is helpful to have a clear diagnosis at baseline before embarking on prolonged treatment with immunotherapy or immunosuppression. Further to this the psychological implications of sudden or indeed gradual onset hair loss in individuals are considerable and thus being able to offer a firm diagnosis, treatment options and a guide to prognosis is of great importance to avoid unnecessary psychological harm.
After a load of tests (? including biopsy) it seems all we have, leaving out the fancy label, is hair loss of unknown cause which resolved spontaneously.
Isn't this a waste of NHS resources?
Re: Sudden onset hair loss and colour change
We would argue that no resources were wasted in this case Sir. Firstly the spontaneous resolution/improvement in this patient’s hair loss occurred after investigations were performed. Investigations were performed with a view to guide possible treatment. Were this patient’s symptoms caused, for example, by telogen effluvium, other than correcting reversible causes such as low ferritin we would have had little to offer with respect to treatments. However as the histology was entirely in keeping with alopecia areata we would have been in a position to offer this gentleman several treatments including treatment with diphencyprone acetate, through our dedicated hair clinic in Greater Glasgow and Clyde. Additionally as alopecia areata is often a chronic condition, and rarely with such rapid resolution as in this case, it is helpful to have a clear diagnosis at baseline before embarking on prolonged treatment with immunotherapy or immunosuppression. Further to this the psychological implications of sudden or indeed gradual onset hair loss in individuals are considerable and thus being able to offer a firm diagnosis, treatment options and a guide to prognosis is of great importance to avoid unnecessary psychological harm.
Competing interests: No competing interests