ALOPECIA AREATA

Alopecia Areata Hair Loss Treatment

A common autoimmune disorder that results in unnatural hair loss. In most cases, the hair loss occurs in small patches whereas in other hair loss can be a lot extreme. Alopecia Areata can affect anyone one irrespective of their age or gender. Mostly it takes place before you enter your thirties. Normally, 1 out of 5 individuals have a family member who has experienced the condition. Alopecia Areate can not be cured but people who have few patches of hair loss often witness complete recovery without any treatment.

CLINICAL PRESENTATION:

• Recurrent non-scarring type of hair loss that can affect any hair-bearing area

• Usually asymptomatic, but some may experience a burning sensation or pruritus in the affected area

• May have few or many patches.

• No correlation exists between the number of patches at onset and subsequent severity

  DIFFERENT HAIR LOSS PATTERN (TYPES):

1. Alopecia areata, localized-usually localized and patchy

2. Circumscribed-isolated oval patches

3. Ophiasis-hair loss localized to the sides and lower back of the head

4. Sisaipho [ophiasis spelled backward]-hair loss spares sides of the back of the head

5. Reticular pattern-innumerable small patches that coalesce

6. Alopecia areata, diffuse-usually see circumscribed patches with alopecia areata but can sometimes see a diffuse pattern which mimics telogen effluvium

7. Alopecia Totalis - complete loss of all scalp hair

8. Alopecia Universalis – complete loss of all body hair

ASSOCIATED CONDITIONS

1. Thyroid disease: Presence of microsomal antibodies is found in 3.3-16% of patients. Antibodies can be found +/- symptoms of thyroid disease, but patients with positive autoantibodies have a higher incidence of functional abnormalities found on thyroid-releasing hormone tests [26% v.s. 2.8%]

2. Vitiligo

3. Atopic dermatitis

4. Collagen vascular diseases have been found in 0.6-2% of patients with AA

5. Emotional stress and psychiatric disease

6. Pernicious anemia, myasthenia gravis, ulcerative colitis, lichen planus, and Candida endocrinopathy syndrome

7. Down syndrome

TREATMENT:

• Rule out fungal infection if scaling is present.

• Rule out syphilis if presentation or history suggests.

• Corticosteroids: Topical/ oral/intralesional steroids are being used in the treatment of AA depending upon its indication.

• PUVA - topical and oral is also one of the treatment options

• Topical and oral immunomodulator creams, lotion & oral medication have been tried with good results.

• Topical minoxidil, stem cell, and peptide preparations are also helpful in the hair regrowth.

• Mesotherapy with special mesococktails can be used for regrowth of hair.

• Platelet-rich plasma (PRP) has been tried for treatment with variable results.

PEARLS & PITFALLS:

Patients and their families often need extensive counseling about this disorder, Especially in a pediatric setting.
Worse prognosis = ophiasis, the age of onset <5 years with alopecia Totalis or Universalis, association with atopy.