Interesting balding without a Norwood Pattern

Because these balding photos do not follow the Norwood scale photos of balding, I doubt that they are genetic.  The diagnosis could likely be made with a hand microscope (trichoscope).  These are the things that the physician should look for with a trichoscope. High on my list of diagnosis, is Alopecia Areata.  Trichotillomania usually doesn’t show such a diffuse pattern but would show blunt amputated hairs. Alopecia Aerata will show exclamation mark hairs.  Lichen planopilaris (an autoimmune disease) includes the absence of follicular openings, perifollicular scaling and white cicatricial areas that point heavily to this diagnosis.  This man’s doctor should certainly biopsy his scalp and send off the tissue scalp samples to an expert dermatopathologist.  That is absolutely the necessary next step after a trichoscopic examination. This man should NOT BE TRANSPLANTED.