P1: SBT
0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6
98 AlopeciaGeneralized Patchy
■Secondary syphilis, “moth-eaten appearance;” usually with a scaly
scalp
ALOPECIA TOTALIS (total scalp)/UNIVERSALIS (total body)– more
severe forms of alopecia areata. Usually preceded by localized alope-
cia areata. Spontaneous remissions and recurrences are the hallmark
of limited alopecia areata. Recovery in alopecia totalis/universalis is
unusual.
Localized Hair Loss
Nonscarring(follicles not destroyed)
■Androgenetic alopecia in men (male-pattern baldness) – genetic,
frontotemporal recession. Loss then occurs on vertex, then density
decreases over top of the scalp.
■Androgenetic in women (female-pattern baldness) – central scalp
regression with retention of frontotemporal hairline
■Alopecia areata – localized hair loss in limited area, usual onset
in young adults and children. Often short broken hairs toward the
periphery of the lesion; noninflamed skin.
■Seborrheic dermatitis
Scarring
■Lichen planus
■Pustular follicular scarring alopecias
➣Dissecting cellulitis
➣Acne keloidalis nuchae
➣Folliculitis decalvans
■Follicular degeneration syndrome
■Localized Scleroderma (en coup de sabre)
■Discoid lupus erythematosus – discrete bald patches showing follic-
ular plugging, erythema, atrophy, scale
■Sarcoidosis
■Amyloidosis
Infection
■Fungal
■Bacterial
Neoplasm
■Metastatic carcinoma
■Lymphomas
■Non-melanoma skin cancer – Basal cell carcinoma or squamous cell
carcinoma