Hair Loss

Dot Hair Loss – 2022

hair loss

Dot Hair Loss

Although not fully known, most suggest an organ-specific autoimmune process that results in follicle destruction. Hair loss…

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Dot Hair Loss

Alopecia areata


Although not fully known, most suggest an organ-specific autoimmune process that results in follicle destruction. Triggering causes are often found – the most common is emotional stress, but certain diseases, such as infections, can also occur. There are no reliable incidence data, but the region can occur at any age, most commonly in the 20-50 age group. It’s like there is no gender difference.

Differential diagnosis
  • Tinea capitis – usually children who have contact with animals or have cases from endemic areas. It can occur as mini-outbreaks involving several children in the family or kindergarten/school. Unlike alopecia areata, there is scaling and redness on the scalp, sometimes with inflammatory infiltrates. The borderline is more irregular and irregularly broken hair occurs in the bald area. Diagnosis is confirmed by fungal culture.
  • Trichotillomania – children and adolescents who often forcibly remove hair from the scalp. The hairless portions are irregular in contrast to the region, with both whole and traumatized hairs in the center of the spot. Sometimes eyebrows and eyelashes are also plucked.
  • Traction alopecia – manifests itself mainly as hair loss in the hairline (or areas where tension is applied), especially in women with a tight-fitting hairstyle (neck knot, ponytail, braids).
  • Secondary to nummular dermatoses – eczema, psoriasis, neurodermatitis – always with more or less scaling, redness and itching. Symptoms of dermatosis are often found elsewhere in the leather garment.
  • Cicatricial (scarred) alopecia – dermatological conditions with bald scarring patches such as discoid lupus erythematosus, folliculitis decalvans.
  • Secondary syphilis – classic malignant appearance with diffuse hair loss and spots of incomplete alopecia.


The patient usually discovers a round, well-defined hairless spot with normal hair around it. The skin is free of irritation and sometimes there may be short clipped hairs on the periphery, hairs called exclamation hairs. The course varies, but most often the condition stops at occasional bald spots in the scalp area and regrows within 2-3 months. More rarely, it continues with more spots that together develop into larger hairless areas. In many cases regrowth can occur here as well, but it is also followed by cyclic repetition. Hair loss extremely rarely progresses to total alopecia affecting the entire scalp or to a universal alopecia as it affects all body hair.


Effective treatment that results in an excellent cosmetic result is lacking. Many different treatment modalities have been tried with DNCB (2,4-dinitrochlorobenzene), such as local sensitization, local irritation (Dithranol), light therapy (PUVA, psoralen and UV light), oral therapy (steroids, zinc). much more without success (even laser!).

Self-healing is preferred for lighter forms with single-site spots. It is worth trying topical treatment daily with a potent steroid solution (Betnovat, Diproderm, Elocon) on bald spots for several months, as the urge for treatment can be strong, it can accelerate natural regrowth. Its effect should be evaluated.

In case of diffuse and recurrent alopecia, it is recommended to contact a dermatologist for confirmation of the diagnosis, additional information and possible further treatment interventions. Advice and assistance with cosmetic measures, eg posture or wig.


It is good for occasional blemishes on the scalp in adulthood. Prognostically unfavorable factors

  • early exit
  • atopic tendency
  • Multiple large spots
  • repetitive course


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