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Scalp lesions

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Due to hormonal changes and a genetic influence, male pattern baldness affects most men at some stage in their lives. Conversion of testosterone to dihydrotestosterone causes the hair follicles to shrink. Approximately half of men aged 50 are balding. This man's alopecia made the patch of vitiligo on his scalp quite obvious. Hairs from the affected areas would have been white or grey if still present. The cause of vitiligo is unknown but is thought to be a systemic autoimmune disorder with a genetic influence. It can affect any part of the body. Melanocytes are destroyed so they cannot produce melanin. The skin pales and is at greater risk of sunburn and cutaneous malignancies. The diagnosis is a clinical one but thyroid function and an autoantibody screen should help to assess the potential for other autoimmune diseases. If treated in the early stages with a topical corticosteroid cream, a calcineurin inhibitor or phototherapy can be helpful but when fully established, cosmetic camouflage can mask the pale skin. Occasionally surgery or skin grafting is considered.

Sun damage

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