(BMJ)—A 56-yo man w/ HTN treated w/ atenolol and ramipril presented w/ rapid-onset hair thinning and color change over 1mo. He described attending a Christmas party w/ “normal” hair, yet by Christmas Day, his hair and beard were white. There was no hx of serious illness/stress, scalp itch, scale, or other rash. Exam: nonpatchy, diffuse hair thinning, sparse beard, no scarring. Labs: WNL. What is the dx?
Zinc deficiency
Telogen effluvium
Alopecia areata
Androgenetic alopecia
Follicular vitiligo
You are correct. Scalp bx confirmed alopecia areata, which preferentially targets pigmented over white hairs, giving the appearance of color change. The course of alopecia areata is unpredictable; up to 50% of pts w/ patchy alopecia areata will experience regrowth w/in 12mo. This pt had regrowth and repigmentation w/in 6mo, suggestive of spontaneous resolution, and therefore declined active tx.

BMJ 2013;347:f6112