Alopecia totalis incognito

Abstract

We report an 11‐year‐old boy with a strong family history of alopecia areata who initially developed alopecia areata with a single circular patch of hair loss on the scalp with exclamation mark hairs at the periphery, which evolved over time into alopecia totalis and then into a novel pattern of hair growth with fine depigmented hair, uniformly 5 mm in length. The hair has not grown any longer over a 48‐month follow‐up period. Scalp biopsies from the occipital scalp demonstrate dense peribulbar lymphocytic infiltrate and uniform miniaturized secondary vellus hairs. This previously undescribed pattern of alopecia areata is remarkable for total lack of alopecia.