When the Algorithm Fails and Experience Wins: An Extraordinary Trichoscopic Case

    January 2026 in “ Forum Dermatologicum ”
    Barbara Olędzka, Michał Piątkiewicz, Adriana Rakowska
    TLDR Thorough hair examination is crucial for accurate diagnosis and treatment.
    A 72-year-old woman with severe hair loss and a history of weak, brittle hair was initially misdiagnosed with alopecia areata, but trichoscopic examination revealed features more consistent with monilethrix, a congenital hair shaft dystrophy. The diagnosis was challenging due to the atypical spacing of hair shaft constrictions, which were unusually far apart. Treatment with oral minoxidil and minimizing mechanical hair trauma led to improved hair density and length. This case highlights the importance of thorough trichoscopic evaluation in distinguishing between alopecia areata and monilethrix, as their hair shaft constrictions differ in distribution and spacing.
    Discuss this study in the Community →

    Related Community Posts Join

    6 / 97 results

      community My experience and a discourse on “DUPA”

      in Chat  46 upvotes 3 years ago
      How diffuse unpatterned alopecia (DUPA) is not an invitation to self-diagnose oneself with aggressive AGA and that seeking a specialized dermatologist may help people experiencing hair loss. Treatment options discussed include topical clobetasol propionate, oral minoxidil, and discontinuing finasteride.
      If You Have DUPA, PLEASE READ THIS: Everyone Should Be Scalp Biopsied

      community If You Have DUPA, PLEASE READ THIS: Everyone Should Be Scalp Biopsied

      by nkrata in Research  830 upvotes 1 year ago
      Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.
      What hair loss pattern is this?

      community What hair loss pattern is this?

      by KyleButler in General  157 upvotes 3 months ago
      The user noticed small circular hairless spots after a buzz cut and has been using finasteride, dutasteride, and oral minoxidil for hair loss. They are experiencing continuous shedding and thinning, and it is suggested they consult a dermatologist for a scalp examination and possible biopsy to determine if it's alopecia areata or androgenetic alopecia.

      community I think I’ve finally found the reason for my hair loss

      in Chat  98 upvotes 1 year ago
      The user experienced hair loss since 2019 and tried finasteride, dutasteride, RU58841, and ketoconazole shampoo without success. A scalp biopsy showed scarring and inflammation from folliculitis, indicating chronic inflammation was affecting treatment effectiveness.

      community 1 month Pyrilutamide. A non responders story to everything.

      in Research/Science  218 upvotes 3 years ago
      My hairline, I am only 23. This conversation is about a user's experience with treatments for androgenic alopecia, including finasteride, dutasteride, RU, minoxidil, progesterone, melatonin, LLLT, oral minoxidil, and Pyrilutamide. They have tried many treatments over the course of two years without seeing much success, and they are considering getting a hair system as a last resort.

    Similar Research

    5 / 1000+ results
      Genetic Hair Disorders: A Review

      research Genetic Hair Disorders: A Review

      26 citations , July 2019 in “Dermatology and Therapy”
      The conclusion is that genetic testing is important for diagnosing and treating various genetic hair disorders.
      Hair Disorders

      research Hair Disorders

      November 2019 in “Harper's Textbook of Pediatric Dermatology”
      Understanding normal hair growth and loss in children is key to diagnosing and treating hair disorders.
      Hair Loss in Children: Diagnosis and Treatment

      research Hair Loss in Children: Diagnosis and Treatment

      24 citations , January 2015 in “Current problems in dermatology”
      The document concludes that accurate diagnosis of hair loss in children is crucial due to limited treatment options and the condition's psychological impact.