Alopecia areata

QUESTION 41

An 11-year-old boy presents to the dermatology clinic with his parents with a 6-month history of progressive hair loss. He feels that larger clumps of hair have been falling out over the past 6 weeks. He remembers having a similar episode several years ago but only had one small patch at that time and never sought treatment. On examination, there are scattered, well-defined patches of alopecia without evidence of scarring (41a, b). On his nails, there is pitting on all 10 fingernails. On trichoscopy, there are yellow dots, black dots and exclamation point hairs within the patches of hair loss.