Alopecia Areata

Clinical scenario: A 10 year old boy presents with asymptomatic hair loss on the scalp for 2
months. He is otherwise well.

Type of cutaneous disorder: non-scarring alopecia

Pathogenesis: autoimmune destruction of hair follicles

Onset: -any age

-usually children
-may be preceeded by stressor

Clinical presentation: -asymptomatic

-single or multiple shiny patches of hair loss
-“exclamation mark” hairs at edge (short, broken-off hairs with pale constricted
area near base)
-sites-usually scalp but may involve beard area, eyebrows or any hair bearing
area
-patches tend to enlarge and may become confluent
-may involve entire scalp (alopecia totalis) or entire body (alopecia universalis)
 “Exclamation mark” hairs

Possible systemic associations: -Lupus Erythematosus

-pernicious anaemia
-type 1 DM
-autoimmune thyroid disease

Course: usually spontaneous regrowth of hair in a few months

Differential Diagnosis:
Trichotillomania
Tinea capitis – but this is scaly as in pic below

Management of alopecia areata:

-Topical treatment
• Potent and superpotent topical steroids
• Intralesional steroids
• Topical irritants eg dithranol, retinoids
-Phototherapy
• Narrowband UVB
• PUVA
• Excimer laser
-Systemic treatment-used in severe progressive disease
• Azathioprine
• Methotrexate
• Cyclosporin
• Sulphasalazine
• Pulsed steroids only for rapidly progressive disease