Peer Reviewed

What’s Your Diagnosis?

Occipital Hair Loss in a 26-Year-Old Man

Rachel Ruda, MD1 • Ford Lannan, MD2 • Kent Handfield, MD2

    1Intern Physician, Walter Reed National Military Medical Center, Bethesda, MD
    2Department of Dermatology at Walter Reed National Military Medical Center, Bethesda, MD

    Ruda R, Lannan F, Handfield K. Occipital hair loss in a 26-year-old man. Consultant. 2023;63(4):e4. doi:10.25270/con.2022.07.000019

    Received September 19, 2021. Accepted September 24, 2021. Published online July 29, 2022.

    The authors report no relevant financial relationships.

    The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US Government.

    Rachel Ruda, MD, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 (


    A 26-year-old man with no significant medical history presented to our clinic with an area of hair loss on his posterior scalp (Figure). He reported first noticing the hair loss 4 years prior to presentation and denied any changes to the area or development of new lesions since onset. He denied any associated symptoms, including pruritus or tenderness.

    A physical examination was notable for a 2.0 × 1.5 cm oval, slightly depressed, partially hairless patch on the occipital scalp. Trichoscopy demonstrated a normal scalp with vellus hairs scattered throughout the patch.


    Figure. Hair loss on the patient’s posterior scalp.


    Based on the patient's presentation, what is your diagnosis?

    1. Alopecia areata
    2. Temporal triangular alopecia
    3. Trichotillomania
    4. Lichen planopilaris
    5. Discoid lupus erythematosus


    Answer and discussion on next page.


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2. Willett MC, Sperling LC. Temporal triangular alopecia acquired in adulthood. Cutis. 2017;100(1):E4-E5.

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