Alopecia Areata — MCQs
A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:
A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
Alopecia areata is:
Which of the following is characteristically seen in alopecia areata?
An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :
A male presents with alopecia and exclamation mark hairs. Diagnosis?
Exclamation mark hair pattern is seen in
A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?
Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?
A 22-year-old woman presents with diffuse hair loss for 1 month. She had a past history of enteric fever 4 months ago. What is the likely cause?
Alopecia Areata Indian Medical PG Practice Questions and MCQs
Question 1: A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:
- A. Atopy
- B. Exclamatory mark
- C. Nail pitting
- D. Geographic tongue (Correct Answer)
Explanation: ***Geographic tongue*** - **Geographic tongue** (benign migratory glossitis) is a benign inflammatory condition of the tongue and is generally not associated with alopecia areata. - While its exact cause is unknown, it's typically linked to genetic factors or sensitivities rather than autoimmune hair loss. *Atopy* - **Atopy**, including conditions like **eczema**, **asthma**, and **allergic rhinitis**, is a well-established association with alopecia areata, suggesting a shared immune dysregulation. - Patients with alopecia areata often have a higher prevalence of **atopic diathesis**. *Exclamatory mark* - The presence of **exclamatory mark hairs** (short, broken hairs that are narrower near the scalp) is a **pathognomonic sign** of active alopecia areata. - These hairs indicate ongoing inflammation and destruction of the hair follicles. *Nail pitting* - **Nail pitting**, characterized by small depressions in the nail plate, is a common finding in patients with alopecia areata, reflecting an immune-mediated attack on the **nail matrix**. - Other nail changes, such as **trachyonychia** (roughened nails), can also occur.
Question 2: A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
- A. Tinea capitis
- B. Cradle cap
- C. Alopecia areata (Correct Answer)
- D. Telogen effluvium
Explanation: ***Alopecia areata*** - This condition is characterized by **localized, well-demarcated patches of complete hair loss** on the scalp. - The underlying skin typically appears **normal, smooth, and healthy**, without inflammation or scaling. *Tinea capitis* - This fungal infection usually presents with **scaly patches**, inflammation, pustules, or "black dots" where hairs have broken off. - The scalp appearance is typically **abnormal** due to scaling and inflammation, unlike the normal scalp seen here. *Cradle cap* - Also known as **seborrheic dermatitis in infants**, it presents as greasy, yellowish, scaly patches on the scalp. - It does not cause **complete hair loss** in localized patches, but rather diffuse scaling and sometimes mild thinning. *Telogen effluvium* - This condition involves **diffuse hair shedding** (increased number of hairs falling out), often triggered by stress, illness, or medications. - It does not present as **localized patches of complete hair loss**, and the hair thinning is generally widespread.
Question 3: Alopecia areata is:
- A. Fungal infection
- B. Cicatricial scar
- C. Telogen effluvium
- D. Non-cicatricial alopecia (Correct Answer)
Explanation: ***Non-cicatricial alopecia*** - **Alopecia areata** is a **non-scarring** form of hair loss, meaning the hair follicles are not permanently destroyed. - The potential for hair regrowth exists because the **follicles remain intact**, even if they are inactive. - It is an **autoimmune condition** characterized by patchy hair loss with "exclamation mark" hairs at the margins. *Fungal infection* - **Fungal infections** of the scalp (tinea capitis) often cause **patchy hair loss** with scaling and inflammation. - Unlike alopecia areata, tinea capitis is caused by a **microorganism** and typically involves an inflammatory response that can be managed with antifungals. *Cicatricial scar* - A **cicatricial scar** (or scarring alopecia) results in the **permanent destruction** of hair follicles, replacing them with fibrotic tissue. - This type of hair loss is **irreversible**, as the follicles are irrevocably damaged and cannot produce hair. *Telogen effluvium* - **Telogen effluvium** is characterized by **diffuse hair shedding** following a triggering event (stress, illness, childbirth). - Unlike the **patchy, localized** hair loss in alopecia areata, telogen effluvium causes **generalized thinning** across the scalp.
Question 4: Which of the following is characteristically seen in alopecia areata?
- A. Fungal infection
- B. Traumatic
- C. Exclamatory mark hair (Correct Answer)
- D. Scarring
Explanation: ***Exclamatory mark hair*** - **Exclamatory mark hairs** are short, broken hairs that get progressively narrower towards the scalp, resembling an exclamation mark. - They are a **pathognomonic sign** of **alopecia areata**, indicating active disease where the hair follicle immune attack is occurring. *Fungal infection* - **Fungal infections** of the scalp (tinea capitis) typically present with **scaling**, inflammation, and often **broken hairs** but not typically exclamatory mark hairs. - Diagnosis is usually confirmed by **KOH microscopy** or fungal culture. *Traumatic* - **Traumatic alopecia** (e.g., traction alopecia, trichotillomania) results from physical damage to the hair shafts or follicles. - It usually presents with **irregular patches** and broken hairs of varying lengths, without the specific exclamatory mark morphology. *Scarring* - **Scarring alopecia** (cicatricial alopecia) involves **permanent destruction** of the hair follicles, leading to irreversible hair loss and replacement by fibrous tissue. - The scalp in these conditions often appears **smooth** and devoid of follicular ostia, distinguishing it from non-scarring alopecia like alopecia areata.
Question 5: An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :
- A. Lichen planus
- B. Tinea Capitis (Correct Answer)
- C. Tinea Barbae
- D. Alopecia areata
Explanation: ***Tinea Capitis*** - **Tinea capitis** typically presents as **localized, non-cicatricial alopecia** with features like **scaling**, **itching**, and broken hairs, which are consistent with the child's symptoms. - It's a common **dermatophyte infection** of the scalp, particularly in children, caused by fungi like *Trichophyton* or *Microsporum*. *Lichen planus* - **Lichen planus** can cause alopecia, but it is typically a **cicatricial (scarring)** alopecia, unlike the non-cicatricial finding described. - It is more commonly associated with **purplish, polygonal, pruritic papules** on the skin and mucous membranes. *Tinea Barbae* - **Tinea barbae** specifically affects the **beard and mustache area** in adult males and would not present as alopecia on the scalp in an 8-year-old child. - It usually involves deep follicular inflammation with **pustules and nodules**. *Alopecia areata* - **Alopecia areata** is characterized by **smooth, circular patches of non-scarring hair loss** without associated scaling or significant itching. - The presence of **scaling and itching** in this case makes alopecia areata less likely.
Question 6: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Telogen effluvium
- B. Androgenic alopecia
- C. Alopecia areata (Correct Answer)
- D. Tinea capitis
Explanation: ***Alopecia areata*** - The presence of **exclamation mark hairs** (hairs that are narrower closer to the scalp and wider at the distal end) is a classic dermatoscopic finding specifically associated with **alopecia areata**. - **Alopecia areata** is an autoimmune condition characterized by patchy hair loss and often presents with these peculiar hair shaft abnormalities. *Telogen effluvium* - This condition involves diffuse thinning of hair, often triggered by stress, illness, or hormonal changes, but does not typically present with **exclamation mark hairs**. - It is characterized by an increased shedding of **telogen (resting phase)** hairs, with no specific hair shaft abnormalities like exclamation marks. *Androgenic alopecia* - This is the most common type of hair loss, characterized by a patterned balding (receding hairline, thinning crown), due to the effect of androgens on genetically susceptible hair follicles. - While it causes hair miniaturization, it does not involve the formation of **exclamation mark hairs**. *Tinea capitis* - This is a **fungal infection** of the scalp that typically causes scaly patches, broken hairs, and sometimes inflammation or painful lesions, often with associated **lymphadenopathy**. - The distinctive **exclamation mark hairs** are not a feature of **tinea capitis**; instead, broken-off hairs or "black dots" may be observed.
Question 7: Exclamation mark hair pattern is seen in
- A. Anagen effluvium
- B. Telogen effluvium
- C. Androgenic alopecia
- D. Alopecia areata (Correct Answer)
Explanation: ***Alopecia areata*** - **Exclamation mark hairs** are a classic diagnostic sign of **alopecia areata**, characterized by hairs that are narrower at the bottom near the scalp and wider at the top. - This pattern results from the sudden interruption of hair growth due to an autoimmune attack on the hair follicles. *Anagen effluvium* - This condition involves the shedding of hair due to early termination of the **anagen (growth) phase**, often caused by chemotherapy. - Hairs typically break off at or near the scalp, leading to diffuse hair loss, but do not show the characteristic "exclamation mark" appearance. *Telogen effluvium* - Characterized by the premature shedding of a large number of **telogen (resting) hairs**, usually triggered by significant physiological stress. - The shed hairs are typically mature, club-shaped telogen hairs and do not exhibit the distinctive tapered shape of exclamation mark hairs. *Androgenic alopecia* - Also known as **male- or female-pattern baldness**, this is a genetic and hormonal condition causing progressive thinning of hair. - Hair loss is typically diffuse, miniaturized, and follows a characteristic pattern, but does not present with exclamation mark hairs.
Question 8: A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?
- A. Androgenic alopecia
- B. Anagen effluvium
- C. Alopecia areata (Correct Answer)
- D. Telogen effluvium
Explanation: ***Alopecia areata*** - This condition is characterized by **patchy hair loss** that can affect the scalp, eyebrows, and beard, and is often associated with the presence of **grey hairs** in the affected areas. - It is an **autoimmune disorder** where the immune system mistakenly attacks **hair follicles**, leading to non-scarring hair loss. *Androgenic alopecia* - This is commonly known as **male-pattern baldness** and typically presents as a receding hairline and thinning at the crown. - It is primarily driven by **genetics** and **androgen hormones**, and does not usually involve patchy loss or affect eyebrows and beard in the same way. *Anagen effluvium* - This condition is often caused by **chemotherapy** or other strong chemical exposures, leading to an abrupt and widespread loss of hair during the **anagen (growth) phase**. - Hair loss is typically diffuse and rapid, not usually localized to patches or accompanied by grey hair in specific areas. *Telogen effluvium* - This is a common form of **temporary hair loss** that occurs following a stressful event, fever, childbirth, or severe illness, causing premature shedding of hairs in the **telogen (resting) phase**. - It results in diffuse thinning rather than discrete patchy hair loss and is not typically associated with grey hair in the manner described.
Question 9: Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?
- A. Telogen effluvium (Correct Answer)
- B. Anagen effluvium
- C. Alopecia areata
- D. Androgenetic alopecia
Explanation: ***Telogen effluvium*** - This condition is characterized by an excessive shedding of **club hairs** from the hair follicle, typically occurring 2-4 months after a significant stressor such as **pregnancy and childbirth**. - During pregnancy, high estrogen levels increase the number of follicles in the anagen (growth) phase; after delivery, estrogen drops, and many follicles simultaneously enter the **telogen (resting) phase**, leading to synchronized shedding. *Anagen effluvium* - This type of hair loss is rapid and severe, occurring when a significant percentage of **hair follicles** in the **anagen phase** are abruptly stopped from growing. - It is often seen with **chemotherapy, radiation therapy**, or exposure to toxins, which damage actively dividing hair matrix cells. *Alopecia areata* - This is an **autoimmune condition** where the body's immune system attacks hair follicles, leading to distinct, typically **round patches of hair loss**. - It can affect any hair-bearing area and is not directly linked to hormonal changes post-pregnancy. *Androgenetic alopecia* - Commonly known as **male or female pattern baldness**, this is a genetic condition influenced by androgens, characterized by a progressive **miniaturization of hair follicles**. - It presents as a characteristic pattern of thinning, such as a receding hairline or thinning at the crown, and is not typically a rapid, diffuse postpartum event.
Question 10: A 22-year-old woman presents with diffuse hair loss for 1 month. She had a past history of enteric fever 4 months ago. What is the likely cause?
- A. Telogen effluvium (Correct Answer)
- B. Androgenic alopecia
- C. Alopecia areata
- D. Anagen effluvium
Explanation: ***Telogen effluvium*** - **Telogen effluvium** is characterized by diffuse hair shedding, often occurring 2-4 months after a significant physiological or psychological stressor, such as **enteric fever**. - The stress prematurely shifts a large number of hair follicles from the **anagen (growth)** phase into the **telogen (resting)** phase, leading to synchronized shedding. *Androgenic alopecia* - This condition presents as a gradual, patterned hair loss, typically characterized by **receding hairline** and thinning at the crown in men. - In women, it often appears as **diffuse thinning** over the crown, but it's not usually acute or triggered by an infection in the manner described. *Alopecia areata* - **Alopecia areata** is an autoimmune condition causing **sudden, well-demarcated patches of hair loss**, not diffuse shedding. - It is frequently associated with other autoimmune diseases, and the hair loss pattern is distinct from the patient's presentation. *Anagen effluvium* - **Anagen effluvium** causes rapid, diffuse hair loss during the **anagen (growth)** phase, often triggered by chemotherapy or radiation. - The onset is typically much faster (days to weeks) after the trigger, unlike the delayed onset seen in this case.
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