• Clinical presentation of alopecia areata
• Clinical presentation of alopecia areata references

Clinical presentation of alopecia areata

Alopecia areata can present in many different forms. Most frequently it develops as a single patch of hair loss a centimeter or two in diameter. This patch of hair loss may develop in any hair bearing region but most frequently it develops on the scalp. The first patch may develop anywhere on the scalp although some dermatologists have attempted to identify the areas where hair loss patches most commonly occur. Anderson (1950) suggested that up to 35% of males developed their first patch of alopecia areata in the occipital area (The hair between the ears at the back of the head) whereas only 15% of females have their first alopecia areata patch in this area. In contrast, 31% of females have first onset in the fronto-vertex region. Where the first patch of hair loss develops is not significant in predicting the future course of alopecia areata. Future hair loss is impossible to predict for any one individual.

About 65% of people with alopecia areata just have one or two patches of hair loss and these often resolve with time. However, some people may later develop more extensive or persistent patterns of alopecia. The first one or two patches may expand in size and/or other patches of hair loss may develop. The hair loss may develop into total scalp hair loss (alopecia totalis) or even complete body hair loss (alopecia universalis). While extensive hair loss usually develops gradually, some individuals can have simultaneous hair loss all over the scalp or body leading to alopecia totalis or universalis in just a couple of weeks.

A few individuals experience diffuse alopecia areata (alopecia diffusa). This can be quite difficult to distinguish from other diffuse forms of hair loss such as telogen effluvium. However, with time a differential diagnosis can be made as telogen effluvium is a limited form of hair loss, it develops over a few months and then stops, whereas diffuse alopecia areata tends to be progressive. A scalp biopsy can be used to distinguish diffuse alopecia areata.

Extensive hair loss only affects a minority of people with around 7% of alopecia areata affected people believed to express alopecia totalis or alopecia universalis (Safavi 1995), although up to 30% has been quoted in the past (Muller 1963). Alopecia areata may last many years with some regrowth, or it may cycle through expression and remission. Alopecia areata runs an unpredictable course. It may only last for a short period of time and normal hair growth can be quickly re- established within months. At first, any hair regrowth tends to be of very fine, unpigmented hair later resuming normal color and texture. Regrowth may occur in one region of the scalp while the hair loss develops in another area. Some people with alopecia areata may experience changes in hair color during, or after, an episode of hair loss and sometimes these color changes can be permanent.

It is possible to have special forms of alopecia areata that are just limited to the eyebrows and/or eyelashes. When alopecia areata first develops in these regions it rarely spreads to the rest of the scalp. However, the reverse is not true. If alopecia areata first appears on the scalp, it may later spread to affect the eyelash and eyebrow areas. It is also possible for men to have alopecia areata limited to the beard area (alopecia barbae).

Alopecia areata may develop in the occipital scalp region and this is called alopecia areata ophiasis. When this happens the alopecia usually does not spread to affect other areas of the scalp. Unfortunately, development of alopecia areata ophiasis is associated with long term persistence and resistance to treatment.

Alopecia areata may also develop at particular sites such as skin nevi. Nevi are spots of skin with properties different from surrounding skin. Moles are the most common example. Normally, alopecia areata is an acquired disease, that is it develops sometime after birth and after at least some hair growth. However, there are a few cases on record of babies being born with congenital alopecia areata.

Anywhere between 7% and 66% of people with alopecia areata also have aberrant nail formation depending on which reports you read (Muller 1963, Baran 1984). It is generally agreed that 25% is a more realistic figure (around the mid point between 7% and 66%). Disruption of growth may involve all of the nails or just one. Nail dystrophy varies from a diffuse, fine pitting to severe alteration in a few cases (Gollinck 1990).

Clinical presentation of alopecia areata references

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