Alopecia with peculiar regrowth pattern

The patient is a 35 year old healthy man who presented with alopecia of the scalp of 1 year duration. Many topical therapies were tried with no response. On examination, there was classical alopecia areata. I gave him IM triamcinolone 40mg injection every 2 weeks with topical Dermovate oinment for 2 months. He came back with hair growth in a wavy pattern in the form of concentric circles (see Figure).. I do not have an explanation. I would...

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From the Nail File

55 year old man with 6 month history of nail distrophy. Only thumbs. He works with his hands cutting film. Trauma likely.The patient wrote:"I noticed left thumbnail change in appearance in late August 2005. I scraped the nail down and got fluid near base. The right thumbnail became abnormal after trauma in October of 2005 showing a crack straight up the middle of the nail."Moderator: I suspect lichen planus. Median nail dystrophy less likely....

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Erythromelanosis Follicularis Facei

The patient is a 15 year old boy with a many year history of ruddy cheeks and a fine follicular eruption in the affected areas. He also has typical keratosis pilaris on his arms and thighs. The diagnosis of erythromelanosis follicularis of the face (also called keratosis pilaris rubra facei) is not difficult. Who has a therapeutic suggestion? I don't think the patient is ready for laser therapy yet. It was difficult to capture the depth of the...

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Nail Dystrophy

This 50 yo man has a three year history of a nail dystrophy.I asked him to write out a detailed history:"Started 18 months ago. Might well have contracted the condition while handling and cutting blocks of cheese as part of my former job. I used to handle and work with dozens of varieties of often moldy cheeses for three hours per week. The condition began with a raised red ridge near the thumbnail. It was a connected series of raised red lumps...

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