Alopecia Areata

Prepared by:Mahima Banjade

Hair Anatomy

• Longitudinal section
• Hair shaft
• Hair follicle
• Infundibulum
• Isthmus
• Inferior segment
• Hair bulb
• Cross section
• Medulla
• Cortex
• Covering layers
• Follicle with inner and outer root sheath
• Shaft with cuticular scales
Alopecia

• It means loss of hair

• 2 types
• Cicatricial alopecia
• Non cicatricial alopecia
Classification
Alopecia areata
 Alopecia Areata

• It is T-cell mediated autoimmune disorder of hair which presents as

discoid patches of hair loss with exlamation mark at the hair edge
where there is no sign of inflammation, scaling, papules, atrophy
and no prutitus

• It is a common type of alopecia

• It affects both male and females equally in all age groups

 Aetiology

• Uncertain but following factors are postulated

1. Immunological factors
• Skin specific autoimmune disease with interaction between
CD8+ T cells and hair follicle associated antigens
• It is also associated with other autoimmune diseases

2. Genetic factors
• It may be genetic because it is found in some families

3. Emotional factors
• In some cases precipitated by emotional stress
 Clinical features

• Hair loss with discoid patches in parietal scalp with no sign of

inflammation, scaling, papules, atrophy and no prutitus

• Pathognomonic sign
• Presence of exclamation mark hairs at periphery of the lesion
• Thinning of hair towards scalp

• Site
• Primarily in scalp, moustache and beard area but sometimes in
eyelashes and eyebrows
 Scalp

Sites of A. areata

Eyebrow

Exclamation mark hair ! Beard and moustache

 Variants
1. Alopecia monolocularis
•  Baldness in only one spot

2. Alopecia multilocularis
• Multiple areas of hair loss

3. Ophiasis
• It is a form of alopecia areata characterized by the loss of hair in the shape of a wave
at the circumference of the head

4. Alopecia totalis
• Loss of hair from the full scalp

5. Alopecia universalis
• Loss of hair from whole body
 A. multilocularis
A. monolocularis

Ophiasis
A. totalis
A. universalis
Figure: Schematic representation of different types of alopecia
Associations

• Nail
• Fine pitting and thinning of nails
• Onycholysis,trachyonychia,onychorrhexis
• Atopy
• Allergic rhinitis, atopic dermatitis and asthma
• Poor prognosis
• Others
• Autoimmune thyroid diseases
• Vitiligo
• IBD
• Type 1 DM
• Autoimmune polyendocrinopathy syndrome
 Trachyonychia

Longitudinal lines of regular nail pitting

 Course
• Not predictable

• Single lesion recovery faster than in more lesions

• Regrowth of hair

• From centre with fine and grey hair which gradually regains
normal thickness and color

• Vellous hair (white or grey) to Teminal hair growth(black)

• May remain grey in elderly

• Poor prognostic features:

-In early onset alopecia, hx of atopy, widespread alopecia,

ophiasis
Diagnosis

• No investigation is needed

• Diagnosis on the basis of clinical picture

• Scalp biopsy
• Can be done which shows characteristic feature of a
peribulbar lymphocytic infiltrate, which is described as
appearing similar to a swarm of bees
 Figures showing swarm of bee appearance in
histology of scalp biopsy from lesion of A. areata
Differentials
Management

1. Addressing psychological needs of patients

2. Counselling

3. Offering treatment to patients who desire interventions

4. Non medical treatment

Management

Table: Medical management of Alopecia areata

Treatment

Few lesions
• <6 months duration: Observe, as spontaneous regrowth
frequent.
• >6 months duration: Topical therapy with steroids,
minoxidil, PUVA/PUVA sol.
Treatment

• Extensive lesions
• Oral steroids: May be used, but withdrawal often results in a
relapse.
• Weekly doses of steroids given as oral mini pulse
• Betamethasone initially 5 mg once or twice a week, then
tapered gradually
• Associated with side effects
Psoralens and UVA (PUVA):
• Used in extensive lesions.
• Can be combined with oral steroids given as OMP in rapidly
progressing and extensive lesions.
• Contact sensitizers like diphencyprone have shown
promising results.
• Cosmetic cover in the form of wigs for alopecia totalis
Non‐medical treatments

• Women with extensive alopecia will usually benefit from

wearing a wig, hairpiece or bandana.
• Men tend to shave their heads although some opt for a wig.
• The use of semi-permanent tattooing can be helpful to
disguise the loss of eyebrows.
References

• lllustrated synopsis of dematology and sexually transmitted disease.

Neena Khanna 4th edition
• UP TO DATE
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