Snapshot A 23-year-old man with a past medical history of vitiligo comes to the dermatologist for multiple, round patches of painless bald spots on his scalp and eyebrows. He denies pulling any hair out intentionally. There is notably no scarring, erythema, or inflammation. Nail exam reveals pitting of the nail plate. He has an extensive family history of autoimmune diseases. Introduction Chronic, autoimmune non-scarring hair loss disorder login to view 1 more bullet Variants login to view 4 more bullets Associated conditions login to view 1 more bullet Epidemiology Rare (1.7% lifetime risk of developing disease) Affects males and females equally Affects children and adults equally Presentation Symptoms login to view 5 more bullets Evaluation Clinical evaluation of hair loss sites login to view 4 more bullets Punch biopsy login to view 1 more bullet Laboratory studies normal Differential Diagnosis Tinea capitis Trichotillomania (nervous hair pulling) Androgenetic alopecia Cicatricial alopecia Telogen effluvium Traction alopecia login to view 1 more bullet Treatment In many cases, hair may regrow spontaneously Limited therapies available; all with limited efficacy login to view 5 more bullets Currently under investigation: targeted oral immunotherapies login to view 1 more bullet Prognosis, Prevention, and Complications Variable, unpredictable pattern of regrowth, patchy hair loss, and progression to alopecia totalis or universalis Complications login to view 1 more bullet Quality of life often impacted