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FIGURE 88.23 Inflammation characteristic of a kerion.

In the differential diagnosis of patchy hair loss, as is seen in tinea capitis, the
clinician should consider alopecia areata ( Fig. 88.24 ). However, with alopecia
areata, no inflammation or scaling of the scalp occurs. Trichotillomania (also
trichotillosis ), the term given to the habit children develop of rubbing, twirling,
or playing with their hair to the point that the hair breaks and is lost in irregular
sometimes geometric patches, should also be considered. Hairs are
characteristically of different length within the affected area, indicating breakage
at different times. In addition, there is no scaling or inflammation typically seen.
Traction alopecia occurs with certain hairstyles. Hair is lost at the margins of the
hairline with the ponytail style or frequent use of tight hair styles. At times,
papules or pustules occur where the skin has been disrupted by the traction.
Infants who are left on their backs for long periods may lose hair at the occiput
from the constant friction in that area.