Scarring Alopecias — MCQs
A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:
Non-scarring alopecia is associated with all except?
Scarring alopecia is seen in:
An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :
A patient with typical cutaneous lesions, slightly elevated red or purple macules often covered by gray or yellow adherent scales. Forceful removal of the scale reveals numerous ‘carpet tack’ extensions. The lesion is:
A male presents with alopecia and exclamation mark hairs. Diagnosis?
All of the following are true for pseudopelade of Brocq except?
A male presents with alopecia and exclamation mark hairs. Diagnosis?
Swarm of bees appearance seen in?
Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?
Scarring Alopecias 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: Non-scarring alopecia is associated with all except?
- A. Telogen effluvium
- B. Androgenetic alopecia
- C. Alopecia areata
- D. Frontal fibrosing alopecia (Correct Answer)
Explanation: ***Frontal fibrosing alopecia*** - This condition is a form of **lichen planopilaris**, which causes **scarring alopecia** due to destruction of hair follicles and replacement with fibrous tissue. - It results in a **receding hairline** and eyebrow loss, with irreversible hair loss. *Telogen effluvium* - This is a common cause of **non-scarring alopecia**, characterized by diffuse hair shedding triggered by various stressors like illness, stress, or medications. - The hair follicles enter the **telogen phase** prematurely, leading to increased shedding but typically regrowth once the trigger is removed. *Androgenetic alopecia* - Often referred to as **male or female pattern baldness**, this is a form of **non-scarring alopecia** driven by genetic predisposition and androgens. - It causes a progressive miniaturization of hair follicles, leading to thinning hair, but the follicles remain present and capable of producing hair. *Alopecia areata* - This is an **autoimmune condition** that causes **non-scarring hair loss** in patches on the scalp or other parts of the body. - The hair follicles are attacked by the immune system but are not permanently destroyed, allowing for potential regrowth.
Question 3: Scarring alopecia is seen in:
- A. Tinea capitis
- B. Alopecia areata
- C. Lichen planus (Correct Answer)
- D. Androgenic alopecia
Explanation: ***Lichen planus*** - **Lichen planopilaris**, a follicular variant of lichen planus, is a common cause of **scarring (cicatricial) alopecia**. - It involves lymphohistiocytic inflammation targeting the **hair follicle epithelium**, leading to destruction and permanent hair loss. *T. capitis* - **Tinea capitis** is a fungal infection of the scalp that typically causes **non-scarring alopecia**, usually appearing as broken hairs, scales, and erythema. - While severe, untreated cases can rarely lead to scarring (e.g., in kerion), it is not the primary presentation for scarring alopecia. *Alopecia areata* - **Alopecia areata** is an autoimmune condition causing **non-scarring hair loss** in patches, often with characteristic "exclamation mark" hairs. - The hair follicles are preserved and hair regrowth is possible, which differentiates it from scarring alopecias. *Androgenic alopecia* - **Androgenic alopecia** (male and female pattern baldness) is the most common form of hair loss and is characteristically **non-scarring**. - It is due to the miniaturization of hair follicles under the influence of androgens, but the follicles remain intact.
Question 4: 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 5: A patient with typical cutaneous lesions, slightly elevated red or purple macules often covered by gray or yellow adherent scales. Forceful removal of the scale reveals numerous ‘carpet tack’ extensions. The lesion is:
- A. Scleroderma
- B. DLE (Correct Answer)
- C. SLE
- D. Lichen planus
Explanation: ***DLE*** - **Discoid lupus erythematosus (DLE)** lesions are characterized by **erythematous-to-violaceous plaques**, often with **follicular plugging** and a **firmly adherent scale**. - The "carpet tack" sign refers to the painful, prickly projections observed on the undersurface of a removed scale, indicating keratinous plugs within hair follicles, which is highly suggestive of DLE. *Scleroderma* - **Scleroderma** involves **fibrosis** of the skin, leading to hardening and thickening, often preceded by Raynaud's phenomenon. - It does not typically present with elevated red or purple macules with adherent scales or the "carpet tack" sign. *SLE* - **Systemic lupus erythematosus (SLE)** is a multi-system autoimmune disease that can have cutaneous manifestations, but these are often more diffuse (**malar rash**, photosensitivity) or non-scarring. - While DLE can occur in SLE patients, the description specifically points to the localized, scarring nature of DLE rather than the systemic features of SLE itself. *Lichen planus* - **Lichen planus** typically presents with **pruritic, polygonal, planar, purple papules and plaques** (the "6 Ps"). - While it can have scaling, it does not exhibit the "carpet tack" sign or the distinct follicular plugging seen in DLE.
Question 6: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Alopecia areata (Correct Answer)
- B. Tinea capitis
- C. Telogen effluvium
- D. Androgenic alopecia
Explanation: ***Alopecia areata*** - **Alopecia areata** is characterized by sudden, non-scarring hair loss that can affect any hair-bearing area, including the scalp. - The presence of **exclamation mark hairs** (hairs that are narrower closer to the scalp) is a classic dermatoscopic finding in alopecia areata and is highly suggestive of the diagnosis. *Tinea capitis* - **Tinea capitis** is a fungal infection of the scalp often presenting with scaling, erythema, and broken hairs, but typically not "exclamation mark hairs." - It may cause **patchy alopecia** but is usually associated with inflammation and sometimes pustules. *Telogen effluvium* - **Telogen effluvium** is a diffuse, non-scarring hair shedding that occurs after a stressful event, leading to widespread thinning rather than localized patches. - It primarily involves an increase in the number of hairs in the **telogen (resting) phase** and does not typically feature exclamation mark hairs. *Androgenic alopecia* - **Androgenic alopecia**, or male/female pattern baldness, is characterized by a gradual, patterned hair loss due to genetic and hormonal factors. - It involves the miniaturization of hair follicles and progressive thinning, but it does not present with **exclamation mark hairs** or discrete patches of complete hair loss.
Question 7: All of the following are true for pseudopelade of Brocq except?
- A. Foot print in snow appearance is seen
- B. Presence of pustules (Correct Answer)
- C. Inflammation is absent
- D. Scarring Alopecia
Explanation: ***Presence of pustules*** - Pseudopelade of Brocq is a type of **scarring alopecia** characterized by **atrophic, hairless patches** without significant inflammation or pustules. - The absence of pustules is a distinguishing feature; their presence would suggest a different condition like folliculitis decalvans or dissecting cellulitis. *Foot print in snow appearance is seen* - This description is characteristic of the **atrophic, irregularly shaped** patches of hair loss seen in pseudopelade of Brocq. - The smooth, white, and often depressed areas of skin resemble footprints in freshly fallen snow. *Inflammation is absent* - Pseudopelade of Brocq is known for being a **lymphocytic scarring alopecia** with **minimal to absent clinical inflammation**. - While microscopic inflammation of lymphocytes around the hair follicles is present, it is not outwardly visible, which helps differentiate it from other inflammatory scarring alopecias. *Scarring Alopecia* - Pseudopelade of Brocq is indeed a form of **scarring alopecia**, meaning the hair loss is permanent due to the destruction of hair follicles and subsequent replacement by fibrous tissue. - This leads to irreversible hair loss in the affected areas.
Question 8: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Telogen effluvium
- B. Tinea capitis
- C. Androgenic alopecia
- D. Alopecia areata (Correct Answer)
Explanation: ***Alopecia areata*** - **Exclamation mark hairs**, which are short, broken hairs that taper near the scalp, are a **pathognomonic sign** of alopecia areata. - This condition presents with **non-scarring hair loss**, often in **well-demarcated patches**, consistent with the general term "alopecia." *Telogen effluvium (hair shedding due to stress or other factors)* - Characterized by **diffuse hair shedding** predominantly in the **telogen (resting)** phase, not specifically focal patches or exclamation mark hairs. - Often triggered by significant physical or emotional stress, illness, or medications, and **lacks the characteristic exclamation mark hairs**. *Tinea capitis (fungal infection of the scalp)* - Presents with patches of **scaling, redness, and inflammation**, sometimes with **black dots** (broken hairs at the scalp surface), but not exclamation mark hairs. - Often associated with **lymphadenopathy** and can be diagnosed by **KOH preparation** or fungal culture. *Androgenic alopecia (pattern hair loss)* - Involves a **gradual miniaturization of hair follicles** leading to a receding hairline and/or thinning crown in men, and diffuse thinning in women, following a specific pattern. - It does **not typically feature exclamation mark hairs** or discrete patches of complete hair loss.
Question 9: Swarm of bees appearance seen in?
- A. Telogen effluvium
- B. Alopecia areata (Correct Answer)
- C. Androgenetic alopecia
- D. Anagen effluvium
Explanation: ***Alopecia areata*** - The "swarm of bees" appearance refers to the characteristic **peribulbar lymphocytic inflammation** seen on scalp biopsy in active alopecia areata. - This finding represents an **immune response targeting the hair follicles**, leading to non-scarring hair loss. *Telogen effluvium* - Histologically, telogen effluvium is characterized by a high proportion of **telogen hairs** in the hair counts and **no significant inflammation** around the follicles. - The "swarm of bees" peribulbar infiltrate is not a feature of telogen effluvium, which is typically a reaction to a systemic stressor. *Androgenetic alopecia* - Androgenetic alopecia is characterized by **follicular miniaturization**, where vellus hairs replace terminal hairs, and a **decrease in the number of hair follicles**. - It does not show the "swarm of bees" peribulbar lymphocytic infiltrate; instead, there might be subtle inflammation or fibrosis in advanced stages but not the dense peribulbar type. *Anagen effluvium* - Anagen effluvium is characterized by the **sudden shedding of hairs in the anagen phase** due to a toxic or inflammatory insult disrupting hair matrix keratinocyte proliferation. - Histology often shows **dystrophic anagen hairs** and damaged hair shafts, but not the specific "swarm of bees" lymphocytic infiltrate seen in alopecia areata.
Question 10: 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.
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