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Lichen simplex chronicus — SCE Dermatology MCQ

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HardGeneral dermatology & dermatology in primary health careLichen simplex chronicusSCE Dermatology

A 10-year-old has one typical smooth patch of alopecia areata with exclamation-mark hairs. Growth and examination are normal, and there is no goitre, atopy or family autoimmune history. Which investigation approach is most appropriate?

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Correct answer: E — Use symptom- and risk-directed testing rather than a routine autoimmune screen

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

A is correct. A typical limited patch of alopecia areata is diagnosed clinically. BAD guidance supports investigation when symptoms, examination, family history, comorbidity or diagnostic uncertainty create a specific indication, rather than blanket thyroid, coeliac and connective-tissue screening. Indiscriminate panels create incidental findings and do not improve routine care. Scalp biopsy or fungal investigation is reserved for atypical scale, inflammation, scarring, broken hairs or uncertainty. The consultation should instead address prognosis, treatment preference and psychosocial impact, with follow-up if phenotype changes.

Reference: BAD living guideline for alopecia areata: https://doi.org/10.1093/bjd/ljaf452