A 19-year-old woman notices a circular patch of complete hair loss on her scalp that appeared over two weeks. A few short, tapered, exclamation-mark hairs are seen at the margin, and the nails show regular geometric pitting. Pull test from the edge is positive. What is the most appropriate first-line management for this single small patch?

• A Intralesional triamcinolone acetonide injected into the patch ✓
• B Topical minoxidil 5% solution alone
• C Oral prednisolone 0.5 mg/kg daily for six weeks
• D Topical immunotherapy with diphenylcyclopropenone

Explanation

The exclamation-mark hairs, nail pitting, and positive pull test confirm alopecia areata. For limited patchy disease, intralesional corticosteroid (triamcinolone acetonide) is standard first-line therapy and induces regrowth in most patches within weeks. DPCP contact immunotherapy is reserved for extensive or refractory disease. Systemic steroids produce regrowth but relapse follows cessation and their adverse effect profile precludes routine use for a single patch. Minoxidil alone is an adjunct, not definitive therapy.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.