dimps
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A 5-year-old boy is brought to the clinic by his mother because of the new onset of a flaky scalp and patches of hair loss. He just started preschool 2 months ago and his teacher noted the alopecia during a nap break. His past medical and birth history are insignificant, and he is not on any medications at this time. He has 1 cat and 1 dog at home. On examination, there are multiple circular patches of alopecia studded with black dots on the surface of the scalp. After examining the boy, the mother shows you lesions on her right shoulder. There is an annular erythematous plague with central clearing. The edge is slightly raised and there are tiny vesicles and a fine scale. There is mild lymphadenopathy appreciated. The best next diagnostic step is to
A. exam the boy's hair microscopically with potassium hydroxide
B. inquire about autoimmune diseases in the family and obtain a thyroid function test
C. perform a punch biopsy of the boy's scalp
D. perform a Wood's light exam of the boy's scalp
E. refer him to psychiatry for trichotillomania
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| doc4mindia
Forum Guru
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B. inquire about autoimmune diseases in the family and obtain a thyroid function test as alopecia areata is occasionally associated with Hashimoto's thyroiditis
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| mingle
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D. this is not alopecia but sounds more like a tinea capitus
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| dimps
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The correct answer is A. Examining the hair microscopically with potassium hydroxide (KOH) is correct because this child has tinea capitis secondary to his mother's tinea corporis. Tinea capitis commonly presents as areas of alopecia with studded black dots representing infected hairs broken off at or below the surface of the scalp. Different species of fungus can cause either inflammatory or non-inflammatory lesions. Trichophyton mentagrophytes, the species responsible for both inflammatory tinea capitis and tinea corporis, can result in pain and regional lymphadenopathy. Most commonly, the mode of transmission is child to child in school age children. The fact that this child's mom has classic "ringworm" on her left shoulder, which is usually described as concentric erythematous plaque with central clearing and superficial scales points the differential diagnosis toward a fungal infection. Diagnosis of tinea capitis is usually confirmed with microscopic exam of the hair and looking for ectothrix or endothrix spores
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