Patchy areas of alopecia with broken off hairs and scales at the periphery.

• A. Tinea capitis
• B. Alopecia areata
• C. Seborrheic dermatitis
• D. Cicatricial alopecia

Answer: (A)

The main idea here is recognizing a fungal infection of the scalp, tinea capitis. When dermatophytes invade the hair shaft, they weaken and break hairs as they emerge from the follicle, producing patches of hair loss that are uneven and patchy. The edges of these patches are often scaly, giving a peripheral scaling ring around the alopecic areas. You may also see hairs broken at the scalp surface, sometimes described as black dots. This pattern — patchy, non-scarred hair loss with peripheral scale and broken hairs — is classic for tinea capitis and is more common in children, and it’s contagious.

This helps distinguish it from other causes: alopecia areata typically presents with smooth patches without significant scaling; seborrheic dermatitis causes diffuse scaling and itching rather than focal patchy hair loss with broken hairs; cicatricial (scarring) alopecia involves permanent follicle destruction with scarring and usually presents with thinning that progresses to scarring, not simply broken hairs with peripheral scales.

Diagnosis is supported by a KOH prep or fungal culture, and management requires systemic antifungals (such as griseofulvin or terbinafine) for several weeks, along with treating close contacts.