A preschool-aged girl tells the school nurse that her hair hurts. The nurse finds that the child’s hair has been arranged to cover several small bald spots. Which finding indicates to the nurse that the hair loss is not disease-related?
A.
Ecchymotic blood accumulations.
B.
Evidence of patches of lost hair.
C.
Episodic complaints of pruritus.
D.
Erythema of the localized lesions.
The Correct Answer and Explanation is:
The correct answer is B. Evidence of patches of lost hair.
Explanation:
In preschool-aged children, hair loss can be concerning and may arise from various causes, including medical conditions like alopecia areata, fungal infections, or traction alopecia. However, in this scenario, the girl’s hair has been arranged to cover several small bald spots, and she reports that her hair “hurts.” The finding that indicates the hair loss is not disease-related is the evidence of patches of lost hair.
1. Distinguishing Features: The presence of patches of hair loss (option B) suggests a non-disease-related cause, such as a behavioral issue like hair pulling (trichotillomania) or even an external factor like the tightness of hairstyles. In cases of alopecia areata, the hair loss tends to be sudden and can appear as well-defined patches, often without any other symptoms like pain or discomfort.
2. Analysis of Other Options:
- A. Ecchymotic blood accumulations would indicate trauma or a bleeding disorder, suggesting an underlying medical issue.
- C. Episodic complaints of pruritus (itching) may point toward dermatological conditions such as fungal infections or allergies, which are disease-related.
- D. Erythema of the localized lesions would suggest inflammation or infection, which also indicates a medical concern.
3. Behavioral Implications: The way the child has arranged her hair to cover the bald spots may be a coping mechanism, revealing her awareness of the bald areas. In many cases, children who engage in hair pulling do so out of stress or anxiety rather than a physical disease. Thus, the lack of other alarming symptoms alongside the evidence of patches of hair loss reinforces the idea that this is more behavioral than pathological.
In summary, option B indicates that the hair loss is not disease-related, pointing towards a behavioral cause rather than a medical condition.