Case scenario

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Anthony developed 20-nail dystrophy at the age of 30 months. Six months later he developed a single patch of alopecia areata. Nightly topical application of 0-05% clobetasol dipropionate cream to the patch led to regrowth within 6 weeks, with no obvious cutaneous atrophy. There was some mild associated hypertrichosis of the forehead, which resolved within 6 months of stopping the cream.

Anthony had no family history of alopecia areata, and no history of atopy. Three years later, he re-presented with four patches of alopecia areata, each about 3 cm in diameter. In the intervening time his father had developed alopecia areata of the beard area. Six months of topical corticosteroids therapy failed to stimulate regrowth, but cutaneous atrophy occurred and the treatment was stopped. Topical anthralin therapy was tried for a further 6 months with no result. Topical minoxidil was then tried for 6 months, during which time the alopecia progressed to approximately 50% scalp involvement. The suggestion of intralesional corticosteroids was met with panic and tears, and it was obvious he would need to be physically restrained if this was going to be used. Topical immunotherapy with diphencyprone was tried for 6 months. During this time he progressed to alopecia totalis.

All therapy was ceased. Anthony got a wig. Two years later all the hair spontaneously regrew and he then remained in remission for the following 3 years before being lost to follow up.

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