What are the features "up close" of alopecia areata?

Alopecia areata: what are the features?

When seeing any patient with hair loss, the first question that needs to be answered with 100 % certainty is - what is the diagnosis? Only with the proper diagnosis can the right treatment be planned. 

So what is the diagnosis here?

This individual in the photo to the right has alopecia areata. Most of the short hairs are exclamation mark hairs (arrow0. The long hair in the photo is a very long exclamation mark hair that has not yet broken. For this hair, we use the term tapered hair rather than exclamation mark hair. Black dots (representing hairs broken at the surface & shown with * symbol) and yellow dots (representing hair openings packed with keratin and shown with # symbol) can be seen. In trichotillomania, hairs of different lengths are seen. Black dots are also a feature.

What other diagnoses did I consider?  

The most common causes of hair loss in 7 year old are: alopecia areata, loose anagen syndrome, trichotillomania, traction alopecia, tinea capitis and telogen effluvium. Features of trichotillomania like flame hairs, v-sign, hair powder and tulip hairs not seen in this photo. There are no signs of tinea capitis such as corkscrew hairs, comma hairs or zigzag hairs.

What is the treatment for alopecia areata?

Hair transplant are never an option for alopecia areata. Treatment for alopecia in a 7 year old is different than for 17 year old or 47 year old because we don't start with steroid injections. Class 1 or 2 topical steroids are the way to go (and one can consider occluding it). Generally speaking, I always use minoxidil with all treatments for alopecia areata. If topical steroids don't work to help regrow hair, the next treatment would be anthralin, diphencyprone or squaric acid (all of which serve go create irritation and/or allergy).