Alopecia areata Alopecia areata manifests as nonscarring hair loss and is estimated to have a lifetime prevalence of 1% to 2% in the general population. It affects men and women equally and can happen at any age; peak incidence occurs in the third to fifth decades. Alopecia areata is one of the most common hair disorders of childhood. Alopecia areata is characterized by single or multiple well demarcated patches of hair loss, typically on the scalp and occasionally in the beard, eyebrows, eyelashes, or other hair-bearing areas of the body. Patterns of hair loss due to alopecia areata include the following,: •. Ophiasis inversus (rare): bandlike hair loss on the frontal parietotemporal scalp.

Sudden hair loss in round or irregular patches without the display of an inflamed scalp is referred to as.

Less common forms of alopecia areata include alopecia totalis (complete loss of hair on the scalp) and alopecia universalis (a generalized pattern of total body hair loss). Patients with alopecia areata usually present with massive shedding of hair within a short period. The lesions are typically round or oval well demarcated smooth patches on hair-bearing areas.

The hair cycle has three sequential stages: anagen, catagen, and telogen. In early alopecia areata, the hair follicles enter the late catagen and telogen phases prematurely, resulting in malformation of the hair shaft and subsequent distal fracturing. Mahjong towers eternity free download full version. As a result, short “exclamation point” hairs that taper proximally form and are visible at the margins of the hairless lesions; these hairs are considered pathognomonic of alopecia areata.

Positive results of a hair-pull test at the margins of the lesion indicate an active disease process. Most patients are asymptomatic; a few describe mild-to-moderate pruritus, pain, or a burning sensation before a patch of alopecia appears., Nail dystrophy can be seen in 10% to 66% of patients on careful inspection., The most common nail change appears as an irregular pattern of pitting, sometimes described as “hammered silver” or “sandpaper.” Other presentations include opacification; longitudinal ridging; superficial splitting, thinning or thickening of the nail matrix; and onycholysis with nail loss. A few patients also have associated autoimmune disorders, such as atopic dermatitis, vitiligo, autoimmune diseases (eg, pernicious anemia, lupus erythematosus, rheumatoid arthritis, ulcerative colitis), and endocrine abnormalities (eg, thyroid disease, diabetes).,,, Although the etiology and pathophysiology of alopecia areata are unknown, genetic predisposition and environmental factors are thought to be responsible. About 40% of patients with early-onset alopecia areata have an affected family member. The current hypothesis from animal models attributes alopecia areata to a T lymphocyte autoimmune reaction to hair follicles. A detailed medical history can rule out hair loss from recent stressful life events or severe illness (ie, telogen effluvium) or self-inflicted hair loss secondary to psychiatric conditions (ie, trichotillomania). Diagnosis is most often made clinically, but a skin biopsy of the affected area can be useful in difficult cases to differentiate alopecia areata from androgenetic alopecia, telogen effluvium, and trichotillomania.

Treatment for alopecia areata aims to suppress the autoimmune process and promote regrowth of hair. Wiseman and Shapiro have recommended a useful treatment plan. For patients older than 10 years with less than 50% scalp involvement, first-line therapy consists of intralesional corticosteroids every 4 to 6 weeks for up to 6 months. This can be combined with topical therapies, including 5% minoxidil and potent corticosteroids or short-contact anthralin in isolation.

For patients younger than 10 years with more than 50% scalp involvement, therapy could commence with topical immunomodulatory agents that act as contact sensitizers, including diphenylcyclopropenone, squaric acid dibutyl ester, and dinitrochlorobenzene, followed by the aforementioned topical therapies. Other therapies recommended for children younger than 10 years include topical 5% minoxidil solution with potent corticosteroids or short-contact anthralin in isolation.,, While many cases of alopecia areata resolve spontaneously within a year without medical intervention, some patients have a chronic form of the disease and are unresponsive to therapy. Referral to a dermatologist is recommended for moderate-to-severe cases or if the condition causes patients severe psychosocial distress.