Alopecia Areata

Alopecia Areata, Dermatology Block 5.5

College of Medicine, King Faisal University, AL Ahsa, Saudi Arabia.

Alopecia Areata is A localized loss of hair in round or oval areas with no apparent inflammation of the skin

Prognosis: good for limited involvement. Poor for extensive hair loss.

Management: intralesional triamcinolone effective for limited number of lesions

1. Alopecia Areata Abdullatif Sami Al Rashed Dermatology block 5.5 College of medicine, King Fiasal University Al Ahsa , Saudi Arabia

2. Introduction A localized loss of hair in round or oval areas with no apparent inflammation of the skin. Nonscarring ; hair follicle intact; hair can regrow. Clinical findings: Hair loss ranging from solitary patch to complete loss of all terminal hair. Prognosis : good for limited involvement. Poor for extensive hair loss. Management : intralesional triamcinolone effective for limited number of lesions.

3. Etiology Unknown. Association with other autoimmune diseases and immunophenotyping of lymphocytic infiltrate around hair bulbs suggests an anti–hair bulb autoimmune process

4. Age of Onset Young adults (<25 years) ; children are affected more frequently .

5. Clinical Manifestations Duration of Hair Loss: Gradual over weeks to months . AW: Autoimmune thyroiditis. Down syndrome. Autoimmune poly- endocrinopathy -candidiasis –ectodermal dysplasia syndrome .

6. Hair Round patched of hair loss. Single or multiple. May coalesce . Alopecia often sharply defined with normal-appearing skin with follicular openings present. Exclamation mark hairs. Diagnostic: broken -off stubby hairs (distal ends are broader than proximal ends)

7. Sites of Predilection Scalp most commonly. Any hair -bearing area. Beard, eyebrows, eyelashes , pubic hair.

8. Types Alopecia Areta : Solitary or multiple areas of hair loss Alopecia Universalis : Total loss of all terminal body and scalp hair Alopecia Totalis : Total loss of terminal scalp hair . Ophiasis : Bandlike pattern of hair loss over periphery of scalp.

9. Nails Fine pitting “Hammered brass” of dorsal nail plate. Also : mottled lunula , trachyonychia ( rough nails), onychomadesis ( separation of nail from matrix)

10. Differential Diagnosis Tenia Capits E arly scarring alopecia Secondary syphilis (Alopecia areolaris  mouth eaten appearance of the beard) T richotillomania P attern hair loss

11. Lab tests Serology. ANA (to rule out SLE ) rapid plasma reagin (RPR) test (to rule out secondary syphilis) . KOH Preparation. To rule out tinea capitis . Histopathology: Acute lesions show peribulbar , perivascular , and outer root sheath mononuclear cell infiltrate of T cells and macrophages ; follicular dystrophy with abnormal pigmentation and matrix degeneration. May show increased number of catagen / telogen follicles.

12. Course Spontaneous remission more with patchy AA, not with AAT or AAU Poor prognosis if: Late onset Fx of AA Atopy Nail involvement and body hair loss High recurrence

13. Management No curative TTT Psychological support Steroids ( interlesional or systemic) Cyclosporin Oral PUVA ( Photochemotherapy ) . Induction of Allergic Contact Dermatitis: Dinitrochlorobenzene , squaric acid dibutylester , or diphencyprone Causes local discomfort due to allergic contact dermatitis and swelling of regional lymph nodesposes a problem.

14. Reference

15. Thank You 