F10 COEXISTANCE OF DIFFUSE ALOPECIA AREATA WITH ANDROGENETIC ALOPECIA. A DIAGNOSTIC CHALLENGE
Tarajkowska-Olejnik A, Slowinska M, Zegadlo - Mylik A, Baran A, Olszewska M, Rudnicka L
Department of Dermatology CSK MSW iA Warsaw, Poland

Diffuse alopecia areata may mimic clinically androgenetic alopecia. Thus, differential diagnosis of these two conditions may cause difficulties. We describe a 51-old female patient with a 50-years history of hair loss, with several previous alopecia areata treatment attempts. The patient, at her first visit in our department showed significant diffuse alopecia of the scalp, continued since 2004. In addition to hair loss, lack of one eyebrow was observed. Otherwise no other hair or skin abnormality was observed. The patient was treated with levothyroxine sodium from 15 years, due to chronic thyroiditis (Hashimoto's disease). All basic laboratory findings, including testosterone, DHEAS, progesterone and prolactine levels were within the normal range, except for a low estradiol level. Histopathology of scalp skin from the affected parietal area showed diminution of follicular size, no signs of lymphocytic infiltrates surrounding hair follicles and slight perifollicular fibrosis. Systemic therapy with cyclosporine A at a dose of 100 mg per day was introduced (1,1 mg/kg/d). After 6 weeks, slow hair regrowth within the temporal and occipital area as well as signs of full regrowth of the eyebrow could be observed. After 6 months of treatment significant improvement was observed but at this point the patient showed clinical appearance characteristic for androgenetic alopecia with typical thinning of hair shaft and diffuse hair loss across the vertex with a marginal frontal hair line spared. The treatment was discontinued due to patient's absence in outpatients clinic on next routine control visits. In conclusion, this case demonstrates that in case of diffuse alopecia areata coexistence with androgenetic alopecia should be considered.