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Clinical and Developmental Immunology
Volume 10, Issue 2-4, Pages 193-195

Pseudo Alopecia Areata Caused by Skull-caps with Metal Pin Fasteners used by Orthodox Jews in Israel

1Clalit Healthcare, Ganey Barnea, Ashkelon, Israel and the Barzilai Medical Center Campus, Ben-Gurion University of the Negev, Ashkelon, Israel
2Department of Dermatology, Barzilai Medical Center Campus, Ben-Gurion University of the Negev, Ashkelon, Israel
3Department of Dermatology, Remez Medical Center, Rehovot, Israel

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Alopecia Areata (AA) is a disease characterized by hair loss that is widely believed to be autoimmune in origin. Thus treatment is generally aimed in this direction using immune inhibitors such as steroids and PUVA.

Objective: To describe a variant of AA, Pseudo Alopecia Areata, caused by a particular cupola pin holder (tic-tac) and to offer a non-pharmacological treatment option (NPT).

Methods: A prospective open label study in 37 Jewish religious patients (34 males, 3 females, mean 35 ± 2 years), previously diagnosed and treated for scalp AA were randomly referred to one of the three NPT intervention methods: small cupola held by two pins, large cupola held by one pin and similar cupola held by a different pin.

Results: Three of the ten patients (33.3%) from the first group developed secondary AA from the additional pin. No changes were seen in the second group. Ten of the seventeen patients (58.8%) from the third group achieved immediate improvement subsequent to replacing the original pin with a new one on a larger cupola.

Conclusions: Conservative pharmacological treatment failed to repair the lesions. The addition of a second pin caused an additional lesion. In contrast, replacing the cupola with a larger one and the original pin-fastener with a different type, successfully reduced the lesions.