Alopecia Areata

Key Points
Presents as round patches of hair loss, most commonly on the scalp
Exact cause is unknown, but is thought to be autoimmune in origin
Tends to run in families

Alopecia Areata consists of round patches of hair loss, most commonly on the scalp. It may, in some cases, be accompanied by loss of eyebrow hair or eyelashes, or beard hair in men.. Occasionally, a more diffuse pattern of hair loss may be present. Pitting and ridging of the fingernails can occur.

It is thought that alopecia areata represents an autoimmune disorder, with resultant inflammatory damage to the root of the hair follicle. Although unsightly hair loss characterizes this condition, general health is not affected. Occasionally, other autoimmune conditions may occur in association with alopecia areata, most commonly thyroid disease..

Differential Diagnosis (Other conditions with similar appearance)
Tinea capitis
Trichotillomania
Discoid lupus

syphilis

telogen effluvium

Diagnosis
Key Points
Diagnosis based on clinical appearance
Blood tests, fungal culture or scalp biopsy may be performed to if the diagnosis is in doubt or if other autoimmune disorders are suspected.

Alopecia areata is diagnosed based on the clinical appearance of well defined, rounded patches of complete or partial hair loss of the scalp, eyebrows, eyelashes, or beard area,and further classified by severity. Alopecia totalis refers to loss of all hair on the head, and aloppecia universalis means loss of all hair on the entire body.

Treatment

No uniformly effective treatment is available
Goal of treatment is to halt progression of hair loss, and expedite regrowth
Most treatments are local although systemic (oral) medicatons are available

OTC Options: Rogaine® (minoxidil)

There is no reliably effective treatment. In many cases, the lost hair may grow back spontaneously even without therapy.When hair does regrow, the hair shafts may temporarily appear grey or white. OTC Minoxidil (Rogaine®), which is usually used for normal male and female pattern hair loss, may be used for several months to facilitate regrowth in alopecia areata.

Physicians have several options in treating alopecia areata. For relatively few localized lesions of alopecia areata, intralesional injections of corticosteroid (directly into the affected areas) are often effective, but may need to be repeeated. Topical medications containing anti-inflammatory corticosteroids (such as clobetasol propionate), irritants (e.g. anthralin) may be used as well. Topical sensitization with squaric acid dibutyl ester is a prolonged and inconvenient treatment option, but is helpful in some patients.Phototherapy (treatment with ultraviolet light) has also been shown to be of benefit. Short courses of oral corticosteroids can be employed in severe or stubborn cases.