SUBJECTIVE: The patient is a (XX)-year-old seen in consultation because of alopecia areata. The patient was accompanied by her mother today. She has a 12-month history of alopecia areata and has been under the care of Dr. John Doe. Initially, she had patchy areas of alopecia around the frontal scalp, which did respond to intralesional steroids. However, the alopecia became more extensive and no longer seemed to respond to intralesional steroid injections. In February, the patient was seen by Jane Doe, and according to the mother, sulfasalazine treatment was recommended. Dr. John Doe opted rather to treat the patient with squaric acid treatment. She was not able to complete the course of squaric acid treatment because of severe irritation and discomfort from the treatment. The patient saw the referring physician in September, and she told the patient to come in so she could be seen by multiple dermatologists. Other treatments that have been tried while she was under the care of Dr. John Doe include Protopic without improvement and topical clobetasol cream.
PAST MEDICAL HISTORY: Negative for autoimmune disorders. She is otherwise healthy.
MEDICATIONS: None.
ALLERGIES: NONE.
FAMILY HISTORY: Father developed alopecia areata subsequent to daughter’s diagnosis.
SOCIAL HISTORY: The patient is a student and uses sunscreen prior to activities.
OBJECTIVE: Examination limited to the head and neck area shows, after removal of hair prosthesis, alopecia involving approximately 50-60% of her total scalp. There is complete hair loss with no evidence of scarring in the parietal and occipital area with a few white terminal hairs within these large patches of alopecia. There are normal appearing areas of hair around her frontal and scalp temples and patchy distribution on the vertex of the scalp. There is no loss of eyebrow or eyelashes area. The patient denies loss of any body hair.
ASSESSMENT: Alopecia areata in an ophiasis pattern.
PLAN: The patient was seen additionally by two other doctors who concurred with the diagnosis and treatment plan that was discussed with the patient and her mother. We discussed with the mother that sulfasalazine has been reported to be useful in alopecia areata based on one published study and report is that 23% of patients had regrowth with alopecia areata treated with sulfasalazine. We discussed with the patient and her mother that neither me nor the other doctors consulted has had any experience with the use of sulfasalazine in alopecia areata. Discussed with them that another alternative, that may be helpful, is topical anthralin treatment in combination with topical minoxidil. She has never had either of these medications in the interest of trying to avoid potential side effects. Certainly, the topical treatment has lots of potential side effects than sulfasalazine. Mother and the patient decided to go along with that treatment first. She is going to begin Drithocreme 1% starting at 10 minutes titrating up to 30 minutes over 3 weeks. The patient was cautioned about staining of clothing, bathroom fixtures, etc. from the medication and begin Rogaine 5% solution b.i.d., of which the patient was cautioned about potential for facial hair regrowth or change with the facial hair growth. Followup is scheduled in six weeks with the referring doctor.
