Other nail changes include koilonychias, onycholysis, onychomadesis, punctuate leukonychia, trachyonychia, Beau’s lines and red lunulae 8-11.ī) Ocular changes: Various ocular changes have been reported to occur in alopecia areata. Upon regrowth, hairs will often initially lack pigment resulting in blonde or white hairs 7.Įxtrafollicular involvement in alopecia areata:Ī) Nail changes: Nail changes are more frequent in children (12%) than in adults (3.3%) 8.The prevalence of nail changes is greater in the more severe forms of alopecia areata such as alopecia universalis and alopecia totalisFinger nails are more commonly involved than the toe nails. Often, distinct patches merge to form large patches. In alopecia areata, the hair loss progresses in a circumferential pattern. These are the hairs in which there occurs a fracture of the shaft inside the hair follicle, producing blackened points inside the follicular ostia resembling comedones. In the chronic phases, the test is negative, since the hair is not plucked as easily as in the acute phases.Īnother important clinical sign that can aid in the diagnosis is the presence of ‘cadaverous hair’. Hair pull test conducted at the periphery of the lesion may be positively correlated (six or more) with disease activity. Although not absolutely pathognomonic, it strongly suggests the diagnosis of alopecia areata. These hairs may also demonstrate deposition of melanin pigment in the distal extremity, also known as Wildy’s sign. The hairs are tapered towards the scalp end with thickening at the distal end. Characteristic hairs, known as ‘exclamation point hairs’ may be seen within or around the areas of alopecia. The affected hairs undergo an abrupt conversion from anagen to telogen, clinically seen as localized shedding. The patches of alopecia areata are usually asymptomatic, although several patients may sometimes complain of local paraesthesia, pruritus or pain. In acute phases, the lesions can be slightly erythematous and oedematous. It usually has a distinctive border where normal hair demarcates the periphery of the lesion. The patch of alopecia may be isolated or there may be numerous patches. The lesion is usually a round or oval flat patch of alopecia with normal skin colour and texture involving the scalp or any other region of the body. Progressive alopecia areata is associated with severe social and emotional impact.Īlopecia areata mostly presents as a sudden loss of hair in well demarcated localized areas. The condition is thought to be self-limited in majority of cases, but in some the disease has a progressive course and needs active treatment in the form of oral or topical therapeutic options. Histopathologically, alopecia areata is characterized by an increase in the number of catagen and telogen follicles and the presence of perifollicular lymphocytic infiltrate around the anagen phase hair follicles. Both the sexes are equally affected and there is no racial variation reportedClinically, alopecia areata may present as a single well demarcated patch of hair loss, multiple patches, or extensive hair loss in the form of total loss of scalp hair (alopecia totalis) or loss of entire scalp and body hair (alopecia universalis). The disease can begin at any age, but the peak incidence is between 20 and 50 years of age 5. The term ‘alopecia areata’ was first used for this disorder by Savages 1.Alopecia areata has a reported incidence of 0.1-0.2%, with a life-time risk of 1.7% 2-4. Although the etiopathogenesis of alopecia areata is still unknown, the most widely accepted hypothesis is that it is a T-cell mediated autoimmune condition that occurs in genetically predisposed individuals. Keywords: Alopecia areata, treatment, autoimmune, corticosteroids, recent advances, contact sensitizersĪlopecia areata is a non-scarring autoimmune, inflammatory hair loss affecting the scalp and/or body. Various therapeutic approaches are presently available for managing alopecia areata including corticosteroids, contact sensitizers and immunosuppressants, but none have been shown to alter the course of the disease on a consistent basis. This disorder occurs in both the sexes, in all age groups, and is characterized by the sudden appearance of circumscribed areas of hair loss on the scalp or other parts of the body. Cite this article as: BJMP 2012 5(3):a530Īlopecia areata is a common, non-scarring, autoimmune disorder affecting any hair-bearing area.
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