Exam shows circular area of nonscarring alopecia incidentally found in an adult patient
- Alopecia areata is a chronic inflammatory disease
which affects the hair follicles and sometimes the nails
- Affects 1 in 1000 people worldwide; in the USA
- Affects patients at all ages including children
- Alopecia areata is an organ-specific autoimmune disease targeting hair follicles
- Dystrophic changes of anagen follicles along with rapid progression of hair follicles from anagen to catagen and telogen phases are observed
- Pernicious anaemia, SLE, myasthenia gravis, rheumatoid arthritis
- PMR, ulcerative colitis, and lichen planus.
- Autosomal recessive disease autoimmune polyglandular syndrome type 1
- Down's syndrome or Turner's syndrome
- Patches of hair loss on the scalp but any hair-bearing skin can be involved.
- Affected skin may be slightly reddened but otherwise appear normal.
- Short broken hairs (exclamation mark hairs) are
frequently seen around the margins of expanding
patches of alopecia areata.
- The nails are involved in
about 10% of patients referred for specialist advice.
- Up to 25% progress to
total loss of scalp hair (alopecia totalis, AT) or loss of
the entire scalp and body hair (alopecia universalis,
- Also thyroiditis and vitiligo may be seen
- FBC, U&E, LFTs, Autoimmune screen
Poor prognostic factor for alopecia
- Extent of involvement (alopecia totalis/universalis)
- Younger age of onset
- Family history
- Nail changes
- Associated autoimmune disease
- Alopecia areata is difficult to treat and few treatments
have been assessed in randomized controlled trials
areata may cause considerable psychological and social
disability and in some cases, particularly those seen in
secondary care, it may be a chronic and persistent
disease causing extensive or universal hair loss
- Potent topical
corticosteroids are widely used to treat alopecia areata but there is little evidence that they promote hair regrowth. Folliculitis is a common side-effect of
topical corticosteroid treatment.
- Depot corticosteroid injected
intralesionally stimulates hair regrowth at the site of
injection in some patient
- New treatment agents, such as excimer laser, low-dose recombinant interleukin 2, Janus kinase inhibitors, and simvastatin