Q: A year back a tiny pimple was seen on the back side of my head and after a few days my hair started falling. Since then I have been applying deprovat lotion. I am staying in a remote place and for the last two weeks I have taken advice from a skin specialist who prescribed steroid injections (D-Code) and I have been taking steroid injections but there is no recovery yet and now the size of alopecia is 5cm X 6cm.

A:It is difficult to guess the diagnosis on the basis of your narrated features. Most common causes of patchy alopecia based on whether they had no scarring or scarring are: Patchy non-scarring alopecia:- 1. Alopecia areata 2.Tinea capitis 3.Trichotillomania: It is a form of alopecia caused by intentional or unintentional pulling out of the hair. 4.Traumatic alopecia: It is due to traction or pressure. 5.Secondary syphilis: Moth eaten alopecia may be produced. Patchy/Diffuse scarring alopecia:- 1. Physical and chemical injury. 2. Infection - Kerion, favus, herpes zoster, folliculitis decalvans 3. Lichen planus and DLE 4. Pseudopelade: Pseudopelade describes a scarring alopecia, which represents the end stage of an idiopathic or unidentified destructive inflammatory process in the scalp. Characteristically, involves the vertex area of the scalp with crab like extensions. 5. Malignancy - Basal cell carcinoma, squamous cell carcinoma. Your case may be that of lichen planus, DLE or pseudopelade which require skin biopsy from the scalp and other investigations.