Occipital Hair Loss in a 26-Year-Old Man

A 26-year-old man presented with occipital hair loss initially diagnosed as alopecia areata, but after ineffective corticosteroid treatment, a biopsy confirmed temporal triangular alopecia (TTA). TTA is a non-scarring, non-inflammatory alopecia typically acquired in childhood, but rarely in adulthood, and can present as occipital alopecia in up to 2.5% of cases. The condition is characterized by normal follicular openings with vellus hairs and is often mistaken for alopecia areata, which responds to corticosteroids, unlike TTA. The patient chose surgical excision, which resulted in a hypertrophic scar, later corrected for cosmetic improvement.