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Alopecia with perifollicular papules and pustules

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Our 23-year-old patient thought his hair loss was probably “genetic.” But that didn’t explain the painful pustules.


 

References

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

A 23-Year-Old African American Man sought care at our medical center because he had been losing hair over the vertex of his scalp for the past several years. He indicated that his father had early-onset male patterned alopecia. As a result, he considered his hair loss “genetic.” However, he described waxing and waning flares of painful pustules associated with occasional spontaneous bleeding and discharge of purulent material that occurred in the same area as the hair loss.

Physical examination revealed multiple perifollicular papules and pustules on the vertex of his scalp with interspersed patches of alopecia (FIGURE 1). There were no lesions elsewhere on his body and his past medical history was otherwise unremarkable.

FIGURE 1
Alopecia with a painful twist


This 23-year-old patient said that he had spontaneous bleeding and discharge of purulent material in the area of his hair loss.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU MANAGE THIS PATIENT?

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