ALOPECIA AREATA

A round or oval loss of hair without scarring is typical.

Rarely, the beard may be affected.

Alopecia areata (AA) is a common cause in children and young adults of the loss of circular patches of hair. It represent an attack on the hair roots by the body's own immune system.

• Patients with AA are three times more likely to have migraine headaches than controls.
• Patients with AA are four times more likely to have hearing loss than controls.
• AA is the third most common cause of hair loss.
• The lifetime risk in the general population is 1.7%.
• It represents a T-cell-mediated immune attack on the hair causing bald spots.
  
• The target allergen is related to melanin. Thus, patients with both black and white hair can preferentially loose the dark hair.
• About half of patients have onset of the alopecia before 15 years of age.
• About 10% of patients have nail changes including pitting, trachyonychia, and longitudinal ridging.
• Many studies have found Vitamin D levels to be lower in AA patients compared to controls.
  

Clinical

Alopecia areata typically presents with round, bald spots on the scalp. The beard, eyebrows, or eyelashes may be affected but it is unusual for isolated lesions elsewhere on the body. One or more may be present at any one time. The exclamation point hair is characteristic and appears as a short terminal hair, tapered at the proximal end. There is no scarring, scale, or other alteration of the scalp skin.

The follicular openings are not lost in contrast to a scarring alopecia.

Patients may rarely go on to lose extensive amounts of hair of the scalp and body, but again, this is unusual. Most patients regrow their hair. The term alopecia totalis refers to patients who have lost all of their scalp hair. The term alopecia universalis refers to patients who have lost all hair on the scalp and body. All nasal hair may be lost and this can lead to increased nasal inflammation and irritation.

Work up

• Thyroid studies, vitamin D, ferritin (measure of iron) and zinc.
  

Treatment, Brief Overview

• Observation
• Supplement with Vitamin D if low.
• Topical Steroids
• Steroid injections monthly
• Pills like Litfulo or Olumiant, oral JAK inhibitors that are mildly immunosuppressive.

Alopecia areata need not be treated as it is a benign condition and regrowth is typical. In fact, spontaneous remission occurs in up to 80% of patients with limited disease within a year. However, it often causes great embarrassment and thus therapy is often desired to speed regrowth.

RegionalDerm

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