A round to oval bald spot is typical. The skin is normal, without scaling, crusting or scarring.

ALOPECIA AREATA

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.
• 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.
  

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. 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 does not need treatment if the patient does not desire it. 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. The oral JAK inhibitors like Litfulo and Olumiant can be quite effective.

Additional Pictures

So called exclamation point hairs are seen.

Alopecia areata away from the scalp may occur, but is less typical.

RegionalDerm

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