Alopecia areata

Rapid Review of Alopecia Areata

1. Alopecia Areata Rapid and complete loss of hair in one or more round or oval patches on scalp, beard area, eye brows, eye lashes, or (less commonly) rest of the body.

2. Causes and Histology Unknown , Autoimmune (cell mediated immunity)  peribulbar inflammatory cell infiltrate in active state: helper T-cell predominate (cluster like bee swarm) in regrowth state: suppressor T-cell hyperfunction Genetic factor: HLA class II (¼ of patients have positive family history) associated HLA-DR 4 , DR 11 , and QD 7  early onset, severe, and familiar in non-associated  later onset, milder, better prognosis, and less family involvement Early in the disease: T-helper cells aggregate @ peribulbar of anagen and early catagen follicle, makes hair in abnormal catagen phase  persistent telogen. Hair follicle moves up into dermis and remain there.

3. Presentation Uninflamed non-scaly, empty hair follicle patch( es ) of 1-5cm in diameter some resting hairs may be found within the lesion in early cases gray hairs may be spared at lesion periphery, hair may be broken off ~4mm from the scalp with attenuated bulb, narrower and less pigmented proximally ( exclamation point hair ) pathognomonic sign In 1 st attack, regrowth is usual within a few months of new hair  at the lesion center (fine & pale  normal color and thickness) in older patients hair remain white. If relapse occurs  heals slower Sometimes complicates into a. totalis or universalis. Associated with atopy: atopic dermatitis, Down syndrome, lichen planus , SLE, thyroiditis , myasthenia gravis, and vitilligo . 10% nail involvement (uniform pits form 1 or more lines)

4. Differential diagnosis Tinea capitis Early lupus erythematosus Secondary syphilis Congenital triangular alopecia Alopecia neoplastica Trichotillomania

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6. 17 years old male developed smooth shiny patches of complete scalp hair loss and depigmented finger tip macules http://162.129.70.33/images/vitiligo_alopecia_areata_3_080318.jpg

7. 38 years old female developed 4 cm patch of complete hair loss http://162.129.70.33/thumbnails/Alopecia_Areata_1_080326.jpg

8. 35 years old male with well demarcated round 1 cm and 4 cm patches of hair loss Comments: well circumscribed areas of non-scarring alopecia for 2 months. Exclamation point hairs are visible at the periphery of the lesions. http://162.129.70.33/thumbnails/Alopecia_areata_1_080114.jpg

9. 5 cm diameter patch of complete hair loss This 40-year-old woman complained of a hairless patch on the mid scalp for 8 weeks. A laboratory evaluation revealed subclinical hyperthyroidism. http://162.129.70.33/thumbnails/Alopecia_areata_1_070121.jpg

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17. http://www.globalskinatlas.com/upload/lg838_1.jpg History: 27 years old male with 3 months ago started noticing hair loss from left temporal area. Actual lesion is a 5.5 cm alopecic area without atrophy of the skin.

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20. Treatment Inform the patient: either resolves spontaneously with few weeks, other cases resist all forms of treatment. Steroid intralesional injection (localized and cosmetic indication) repeated every 6 weeks Steroid cream applied for wider lesions If no response: topical anthralin 1% cream 15-20min then washed off Minoxidil application trial For extensive cases: induction with squaric acid dibutyl ester, dinitrochlorobenzene , diphencyprone , methoxsalen , and UVA For rapidly progressing lesions: prednisolone

21. Prognosis Poor prognostic factors: Associated with atopic dermatitis Childhood onset Wide spread involvement Opiasis >5 years duration Associated with nail involvement ( onychodystrophy )