Alopecia Areata

General Illness Information


Common Name:

ALOPECIA AREATA

Medical Term: None specified

Description: Sudden hair loss in circular patches on the scalp (in the absence of any other visible skin disorder or systemic disease). Any hairy area may be involved, the scalp and the beard most frequently. Rarely, all the body hair may be lost (Alopecia universalis). Alopecia totalis is loss of all scalp hair and eyebrows. In most cases, the hair grows back in a few months, except in cases with extensive hair loss, in which case re-growth may not occur. It is a relatively common condition, usually affecting young adults (under age 25); children are affected more frequently. It affects males and females equally.

Causes: Unknown. Possible association with auto-immune diseases. Sometimes associated with other auto-immune disorders such as vitiligo, Hashimoto’s thyroiditis and myasthenia gravis.

Prevention: None known.

Signs & Symptoms

  • Sudden hair loss in sharply defined circular patches; Sometimes hair loss occurs over a period of weeks to months; Patches of alopecia areata can be stable and often show spontaneous re-growth over a period of several months, new patches may appear while others resolve;
  • No pain;
  • No itch;
  • Anxiety because of concern about progressive hair loss and balding;
  • Pitting of the nails- looks like hammered brass.

Risk Factors

  • Stress;
  • Family history.

Diagnosis & Treatment

General Measures:

  • Laboratory tests are performed to rule out other causes of hair loss such as lupus, syphilis and fungal infection (tinea capitis). No curative treatment is available. Efficacy of treatment is difficult to assess because of the spontaneous regrowth which, usually occurs in this condition. In most cases, the most important factor in management of the patient is the psychological support from the physician, family and support groups;
  • Shampoo and bathe as usual; this is a non-contagious disorder;
  • Avoid tugging on normal hair close to areas of hair loss;
  • Use of a hairpiece or wig during the acute phase.

Medications:

  • Apply topical steroids once or twice a day unless otherwise directed. Best applied immediately after bathing or shampooing, because of ease of spreading and increased penetration. In special cases, injections of steroids into affected areas and oral cortisone medication may be used;
  • Topical minoxidil (a prescription medication used for hair growth) may help; however, it is very expensive and not always effective;
  • Injections of triamcinolone into the scalp may help in some cases;
  • Photochemotherapy with PUVA may be recommended. The entire body must be exposed, in that the therapy is believed to be a form of systemic immunosuppression. Variably effective- response rate about 30%.

Activity:

No restrictions.

Diet:

No special diet.

Possible Complications:

  • Loss of all hair (alopecia universalis);
  • Slow or incomplete hair growth.

Prognosis

In about 80% of the patients, re-growth occurs. However, re-growth may take up-to a year. Recurrences of alopecia are quiet common. Repeated attacks, nail changes and total alopecia occurring before puberty, are poor prognostic signs. Confluence of lesions in the occipital region is also a poor prognostic sign.

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