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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55505
Experience:  GP in the United States
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My issue started in June 2015. I am British and live in the

Customer Question

My issue started in June 2015. I am British and live in the uk, my wife wife and I went on holiday to Bali and three weeks after my return I noticed a small round patch in the top middle of my eyebrow was missing.
I also noticed this patch was darker with a slightly scaly ring around it. It may have diffused (explain why later) but until this point I never really paid attention to my eyebrows.
I monitored the situation and saw that I started to lose more hair from the same eyebrow in a diffuse type fashion from the middle.
The side next to my nose although thinner is still there and thick as is the side to the side of my face.
I also started noticing when I showered my eyebrow had what I could only describe as white paste, this wasn't always present sometimes there and sometimes no.
I went to the doctor who checked my scalp I had not a single patch of hair loss and my other eyebrow is completely unaffected. He initially said alone is areata and to leave it as it will come back.
The diffuse hair loss continued only in this eyebrow, again from the middle part.
I noticed hits would grow back but I would touch them and they would snap off, this process repeated all the time.
My doctors trips became more frequent, he took my bloods which all came back normal, and thyroid etc normal.
A few months later I went back to the doctors where I was examined again, again nothing missing from scalp or other eyebrow. But this time he saw the diffuse hair loss pattern properly and said it was most likely fungal.
He prescribed me oral terbinafine and topical micronazle. The pills I'm still on (6 weeks course) the topical I did try a few times but I couldn't keep the regimented three times a day needed.
At this point I decided to visit a dermatologist who on examining me noted: no exclamation point hairs in my thinned eyebrow, no hair loss patches from my scalp not anywhere else. She said on physical examination its 70/30 in favour of fungus over alopecia areata
She took a scraping which she had to have sent away for analysis, by this point I had been on oral terbinafine for 72 hours and although not religiously applied the micronazle.
4 weeks later the fungal results came back negative, I asked her if the antifungals could prejudice the results as I read it online, I also read that if the sample is not properly kept at a correct temperature etc it could also prejudice the results, in her case the samples had to be transported 40 miles and we had the cams break in between.
I am seeing what I believe to be regrowth (I am 4 weeks into the 6 weeks of terbinafine) I see black dots in many places although I'm paranoid those could be broken hairs.
I suffer from mild psoriasis also I have a few patches on my legs (coin size) and small bits on my scalp. This is have had for 6 years and use topical steroid ointment.
That's the whole history, is it possible the fungal test was a false negative? Is diffuse alopecia areata common in one eyebrow only no where else?
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
Just realised the autocorrect errors:Not anywhere else should be nor anywhere elseCams break should be xmas breakSorry!
Expert:  Dr. Phil, MD replied 1 year ago.
Thanks for this question.Do you still need help on this?
Customer: replied 1 year ago.
yes please :0)
Expert:  Dr. Phil, MD replied 1 year ago.
can you attach a picture of the rash?
Customer: replied 1 year ago.
I can send you two photos: one taken in early july 2014 when I started noticing and one from today, would that help?
Expert:  Dr. Phil, MD replied 1 year ago.
yes, absolutely
Customer: replied 1 year ago.
Sorry I meant July 2015 and a recent one. Please note hair grows but its brittle and falls off quickly this process has happened since July 2015
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, I'm quite sure this is fungal.AbsolutelyYou need to be on oral and topical antifungalsI think the fact that you were on antifungals messed with the sample
Customer: replied 1 year ago.
I emailed the dermatologist that very same question: did the terbanifine mess up the results? her response made little sense to me (I'm a software engineer, not a doctor [maybe I should be answering in the computing section lol!]) anyway, here is what I asked her, followed by her response, to me it makes no sense, what do you think?my mail:I received a letter from yourself yesterday regarding the Mycology results.They came back as negative for fungus, and this has led a few questions to pop up in my mind which I thought I should ask you.When examined your observation was that it was up 70/30 in favour of fungus and not Alopecia Areata (lack of exclamation mark hairs and signs of regrowth which were typically not in line with regrowth time cycles)Prior to the scraping:I had already been taking Terbinafine orally for two days and ten days prior to this I had been applying (although for my sins!) not three times a day as directed, more like once a day Hydrocortisone / Miconazole which my GP had prescribed.I am wondering if this could have resulted in a negative fungal result?Her Mail:Thank you for your email. You are quite right in that if you have been taking oral antifungals and you are applying an antifungal cream to your skin it might affect the results. However usually although the antifungals kill the fungus and may prevent it from growing in the laboratory, the fungal hyphae can usually be seen down the microscope even if they cannot be grown on culture.
Expert:  Dr. Phil, MD replied 1 year ago.
This means that she is saying even if the anti fungal killed the fungus, you would see the dead bodies basically
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Customer: replied 1 year ago.
So does that rule out fungus? this is why i'm so confused, I have no exclamation mark hairs, the alopecia is diffuse on one eyebrow only, I have no hair loss anywhere else, she basically said there were two things: Alopecia Areata or Fungus, on her physical exam she ruled in 70% in favour of fungus yet the results said no?
Expert:  Dr. Phil, MD replied 1 year ago.
No, it doesn't rule out fungusI would go ahead and treat it as fungalThe results were a false negative IMO
Customer: replied 1 year ago.
Ok you're probably going to get sick of me..... (i bought my doctor a very expensive bottle of single malt to say thanks!!) is it fair to say i should rule out Alopecia Areata and think of this as Fungal? Also I forgot to add I practice Krav Maga every week (which is very hot and sweaty and close contact with many other people)
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, I would rule it out and treat it as fungalI'm not sick of you :)
Customer: replied 1 year ago.
awesome thanks! so the 250 mg Oral Terbinafine I am on is the correct medication? I'm no 4.5 weeks into the 6 weeks course
Expert:  Dr. Phil, MD replied 1 year ago.
that is correct.
Customer: replied 1 year ago.
so the black dots are most likely regrowth in your opinion?
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, I believe that
Customer: replied 1 year ago.
one last thing, I have been obsessively checking my brow, and often still when I touch it a few hairs fall out (not as many nor not as easily before the terbinafine) are these simply just weak hairs after the fungus?
Expert:  Dr. Phil, MD replied 1 year ago.
Yes exactly
Customer: replied 1 year ago.
Awesome thank you so much for all your help!
Expert:  Dr. Phil, MD replied 1 year ago.
welcome :)