A child with hair loss

REPORT OF A CASE A 2-year-old boy was evaluated for hair loss. His hair was sparse but grossly normal at birth. A hair abnormality was first noted at about 2 months of age. Growth and development were otherwise normal. There was no evidence of hearing loss. The boy's family history revealed no abnormalities of the hair or skin. Physical examination showed several distinct, patchy areas of hair loss, especially involving the parietal and occipital areas of the scalp. The hairs were short in these areas, many being only millimeters in length (Fig 1). Although the hair was dry and lusterless, it had a spangled appearance in reflected light. There was a suggestion of beading (Fig 2). The eyebrows were involved to a lesser extent. The scalp itself was unremarkable. There was mild frontal bossing. The patient's skin, nails, teeth, and oropharyngeal mucosa were normal. Laboratory data showed a serum copper