Androgenic alopecia: an entity to consider in adolescence.

Rodrigues M, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220679 Description A 15-year-old healthy adolescent girl went to her physician consultation because she was preoccupied with progressive thinning of her hair since 11 years old. In the last year, she noticed an aggravation, with an excessive hair loss. She does not have hirsutism, acne, asthenia, menstrual irregularities or weight variations. In her family history, she reported that her mother had ‘excessive hair loss after pregnancy’ and her maternal aunt has alopecia of unknown aetiology. At physical examination it was observed diffuse reduction of capillary thickness and density at the frontal scalp area (figure 1) and vertex (figure 2). Rare black dots were present and the pull test was negative. The analytical study including blood count, iron kinetics, thyroid function and hormonal study had no alterations. The pelvic and adrenal gland’s ultrasound were normal. At dermatology consultation, scalp biopsy revealed findings compatible with androgenic alopecia. She started treatment with oral contraceptive, oral spironolactone and topical minoxidil solution, with improvement of alopecia areas. Androgenic alopecia is the most prevalent form of alopecia in adulthood, but little is known about its prevalence, characteristics and natural history in paediatric population. In children and adolescents with genetic predisposition, the first signs of androgenic alopecia may arise with increased levels of androgens at puberty, but the presence of androgenic alopecia in children with prepubertal testosterone levels and women with