ABIM Dermatology Question of the Week: 22-year-old male with hair loss

As we continue #DermatologyWeek, here is a dermatology question from our ABIM question vault, which will be high-yield for those of you studying for the ABIM, Family Medicine, or USMLE Step exams. Even if you’re not preparing for any exam, give it your best shot and then see below for the answer. You’ll likely expand your Knowmedge in the process.

Question of the Week: Dermatology edition

A 22-year-old male college student is concerned about going bald. He has noticed the distribution of his hair loss to be oval-shaped, progressing over the past three months. He has no medical problems and voices no complaints of decreased libido, heat or cold intolerance, constipation, depression or anxiety, joint pain or skin rashes. He denies scalp itching or dandruff. Basic labs, including thyroid function tests and testosterone, are checked and results are normal.

Which of the following conditions does this patient likely have and what is the best treatment?

A. Trichotillomania and sertraline

B. White patch tinea capitis and griseofulvin

C. Alopecia areata and intralesional steroids

D. Andogrenic alopecia and reassurance

Dermatology Practice Question Explanation

Based on his symptoms, this patient likely has alopecia areata. This is a condition that typically causes one or more round patches of hair loss. Alopecia areata is usually—but not always—associated with autoimmune disorders and patients usually have loss of hair in solitary lesion or patches of hair loss in an oval shape. The best treatment for this condition is Choice C (Intralesional steroids).

Choice A (Trichotillomania) is a condition that is associated with psychiatric problems like obsessive-compulsive disorder in which patients pull their hair out intentionally.
Choice B (White patch tinea capitis) is a dermatophyte infection of the scalp and is treated with anti-fungals like griseofulvin.
Choice D (Androgenic alopecia) is common in older men whose hair loss begins in the front portions of the scalp, known as a “receding hairline.” This is due to conversion of testosterone to dihydrotestosterone; the higher the level of dihydrotestosterone, the greater the chance of hair loss as males get older.
Choice E (Telogen effluvium) is the most common cause of hair loss and is reversible. It can be associated with stress, pregnancy, major surgery or extreme weight loss.

You can find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.