Alopecia areata is an autoimmune disorder characterized by round bald patches on the scalp. Patients can have associated thyroid disease, vitiligo and atopic eczema. Alopecia areata starts in childhood in about 50%. Treatment is based on the extent of the involvement and the age of the patient. Spontaneous regrowth is common.
What is the cause
The exact mechanism is not yet understood. Triggers include emotional and physical stressors, viral infections and hormonal change.
Bald patches may occur in several clinical patterns:
- Patchy alopecia areata: In any hair-bearing area
- Alopecia totalis: Nearly all scalp hair is lost
- Alopecia universalis: Nearly all hair on the entire body is lost
- Ophiasis pattern: alopecia areata affects the hairline
- Alopecia areata of the nails: Regular shallow pitting and ridging
How is alopecia areata diagnosed?
Alopecia areata is diagnosed clinically. Biopsy can confirm the condition.
Can alopecia areata be treated?
Spontaneous regrowth occurs in most patients with a single bald patch. Treatment is based on the extent of involvement and the age of the patient. A combination of therapies are used in resistant cases. The hair may fall out when they are stopped.
Poor prognostic factors include:
- Onset before puberty
- Bald patches persisting for more than 1 year
- Ophiasis pattern
- Extensive disease
- Nails involvement
- Patient with other autoimmune disease, atopy or Down syndrome
- Topical treatment
- Intralesional corticosteroids