Alopecia Areata, Betamethasone, Poliosis, Teledermatology, Triamcinolone



  1. Parker, James K.
  2. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of white sparse eyelashes.


Article Content

In the store-and-forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.




Chief complaint

Presenting for thinning and whitening of the left eyelashes and potential treatment options.


History of present illness

A 55-year-old man presented with whitening and thinning of the eyelashes on his left eye, which he noticed 8 weeks prior. This was associated with patches of hair loss on his arms. Prior treatment: none. His primary symptom: appearance of his eyelid. Prior biopsy: none. Other significant laboratory/study findings: none.



Fully satisfactory.



Two images were provided which showed: white, sparse eyelashes involving the left eyelid (Figure 1); discrete, round, oval patches of alopecia on the dorsal forearm (Figure 2).

Figure 1 - Click to enlarge in new windowFIGURE 1. The left eyelid shows white hairs and thinning of the eyelashes when compared with the right eyelid.
Figure 2 - Click to enlarge in new windowFIGURE 2. A dorsal view of the forearm shows round-oval patches of hair loss.



The morphology of the lesions, distribution, and history are most consistent with poliosis secondary to alopecia areata.



Skin Care Recommendations

Per patient and provider preference, treatment options include topical corticosteroids for the alopecic areas on the arms (e.g., triamcinolone 0.1% ointment or 0.1% betamethasone valerate foam twice daily 5 days per week for up to 12 weeks) with watchful waiting for eyelash regrowth (Burris, Fedorowicz, & Ehrlich, 2016). Assess for underlying systemic disease, for example, thyroid function tests, complete blood count, and antinuclear antibody titer, as symptoms dictate.



Type of Visit

Return to primary care for follow-up after 4 weeks. Refer to dermatology if no improvement in 6 weeks.



Alopecia areata is considered to be a T-cell-mediated autoimmune condition that resolves in most patients with proper treatment and time. Characteristically, the disease has "exclamation point" hair shape, which is composed of a short hair that tapers at the end. Most commonly, it is found on the scalp, but occasionally, it can be seen on the arms, thigh, eyelashes, eyebrows, and face. Patients can experience "overnight graying" because of pigmented hairs preferentially being autoimmune targets, leaving nonpigmented hairs behind (Islam, Leung, Huntley, & Gershwin, 2015). Notably, the activated autoreactive T cells target melanogenesis-associated peptides expressed by anagen hair follicles producing pigment (Islam et al., 2015). Ultimately, this destroys the ability of the hair to anchor itself to the skin, leading to shedding of pigmented hair while sparing unpigmented hair.




Burris K., Fedorowicz Z., Ehrlich A. (2016). Alopecia areata. Retrieved from[Context Link]


Islam N., Leung P. S., Huntley A. C., Gershwin M. E. (2015). The autoimmune basis of alopecia areata: A comprehensive review. Autoimmunity Reviews, 14(2), 81-89. doi:10.1016/j.autrev.2014.10.014 [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287. [Context Link]


1The standardized teledermatology reader report format is available for authors on the journal's Web site ( and on the submissions website online at [Context Link]