Tick-Bite Alopecia of the Scalp in a Child: Case Report and Differential Diagnosis With Alopecia Areata and SENLAT

The case report discusses tick-bite alopecia in a child, highlighting the importance of distinguishing it from alopecia areata and SENLAT. The presence of a bite-centered anatomy, characterized by a tiny eschar or atrophic papule with a narrow, active rim, is a key indicator of tick-bite alopecia. Trichoscopic signs may overlap with alopecia areata, but when these signs are rim-restricted around a bite center, they suggest tick-bite alopecia. Ipsilateral tender cervical lymphadenopathy with a scalp eschar indicates SENLAT and requires empiric doxycycline treatment, while its absence supports conservative management. A short course of high-potency topical corticosteroids is typically effective, with biopsies reserved for atypical cases. Follow-up is essential to monitor for rare progression to an alopecia areata-like effluvium.