Alopecia areata

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Alopecia areata
Alopecia areata.
Classification and external resources
Specialty	Dermatology
ICD-10	L63
ICD-9-CM	704.01
OMIM	104000
DiseasesDB	430
MedlinePlus	001450
eMedicine	derm/14
MeSH	D000506

Alopecia areata (AA), also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body, usually from the scalp due to the body's failure to recognize "self" and destroys its own tissue as if it were an invader.^[1][2] Often it causes bald spots on the scalp, especially in the first stages. In 1–2% of cases, the condition can spread to the entire scalp (alopecia totalis) or to the entire epidermis (alopecia universalis). Conditions resembling AA, and having a similar cause, occur also in other species.^[3]

Contents

 [hide] 

• 1 Classification
• 2 Signs and symptoms
• 3 Diagnosis
• 4 Causes
• 5 Treatment
• 6 Prognosis
• 7 Epidemiology
• 8 Research
• 9 See also
• 10 References
• 11 External links

Classification[edit]

Commonly, alopecia areata involves hair loss in one or more round spots on the scalp.^[2][4]

• Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.^[2]
• Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
• Alopecia areata multilocularis refers to multiple areas of hair loss.
• Ophiasis refers to hair loss in the shape of a wave at the circumference of the head.
• The disease may be limited only to the beard, in which case it is called alopecia areata barbae.^[2]
• If the patient loses all the hair on the scalp, the disease is then called alopecia totalis.
• If all body hair, including pubic hair, is lost, the diagnosis then becomes alopecia universalis.^[5]

Alopecia areata totalis and universalis are rare.^[5]

Signs and symptoms[edit]

Alopecia areata

Typical first symptoms of AA are small bald patches. The underlying skin is unscarred and looks superficially normal. These patches can take many shapes, but are most usually round or oval.^[6] AA most often affects the scalp and beard, but may occur on any hair-bearing part of the body.^[7] Different skin areas can exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. It is common in children.
The area of hair loss may tingle or be painful.^[8]
The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.^[2]
Exclamation point hairs, narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance, are often present.^[2]
When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of AA, hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.^[9]
Nails may have pitting or trachyonychia.^[7]

Diagnosis[edit]

Alopecia areata is usually diagnosed based on clinical features.
Trichoscopy may aid differential diagnosis. In AA, trichoscopy shows regularly distributed "yellow dots" (hyperkeratotic plugs), small exclamation-mark hairs, and "black dots" (destroyed hairs in the hair follicle opening).^[10]
A biopsy is rarely needed in AA. Histologic findings include peribulbar lymphocytic infiltrate ("swarm of bees"). Occasionally, in inactive AA, no inflammatory infiltrates are found. Other helpful findings include pigment incontinence in the hair bulb and follicular stelae, and a shift in the anagen-to-telogen ratio towards telogen.^{[citation needed]}

Causes[edit]

Alopecia areata is not contagious.^[2] It occurs more frequently in people who have affected family members, suggesting heredity may be a factor.^[2] Strong evidence of genetic association with increased risk for AA was found by studying families with two or more affected members. This study identified at least four regions in the genome that are likely to contain these genes.^[11] In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.
The condition is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth.^[2] For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss. A few cases of babies being born with congenital AA have been reported, but these are not cases of autoimmune disease, because an infant is born without a definitely developed immune system.^{[citation needed]}
Endogenous retinoids metabolic defect is a key part of the pathogenesis of the AA.^[12]
In 2010, a genome-wide association study was completed that identified 129 SNPs (single nucleotide polymorphisms) that were associated with alopecia areata. The genes that were identified include regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, Eos, cytomegalovirus UL16-binding protein, and the human leukocyte antigen region. The study also identified two genes, PRDX5 and STX17, that are expressed in the hair follicle.^[13]
Also, some evidence indicates AA affects the part of the hair follicle associated with hair color. Hair that has turned gray may not be affected.^{[citation needed]}

Treatment[edit]

If the affected region is small, it is reasonable to only observe the progression of the illness, as the problem often spontaneously regresses and the hair may grow back.^{[citation needed]}
In cases of severe hair loss, limited success has been shown from treating AA with the corticosteroids clobetasol or fluocinonide, corticosteroid injections, or cream. The cream however is not as effective and it takes longer in order to see results. Steroid injections are commonly used in sites where the areas of hair loss on the head are small or especially where eyebrow hair has been lost. Whether they are effective is uncertain. Some other medications used are minoxidil, Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy cyclosporin, sometimes in different combinations. Topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target,^[7] and small lesions typically also regrow spontaneously. Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs have serious adverse side effects.^[7]

Prognosis[edit]

In most cases which begin with a small number of patches of hair loss, hair grows back after a few months to a year.^[8] In cases with a greater number of patches, hair can either grow back or progress to AA totalis or, in rare cases, AA universalis.^[8]
Effects of AA are mainly psychological (loss of self-image due to hair loss). Loss of hair also means the scalp burns more easily in the sun. Patients may also have aberrant nail formation because keratin forms both hair and nails.
Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, however, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Episodes of AA before puberty predispose one to chronic recurrence of the condition.^[7]
Alopecia can certainly be the cause of psychological stress. Because hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression.

Epidemiology[edit]

The condition affects 0.1%–0.2% of humans,^[14] occurring in both males and females. Alopecia areata occurs in people who are apparently healthy and have no skin disorder.^[7] Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages.^[2] Patients also tend to have a slightly higher incidence of conditions related to the immune system: asthma, allergies, atopic dermal ailments, and hypothyroidism.

Research[edit]

A number of medications are under trial

• Abatacept (Orencia), which is FDA-approved for the treatment of rheumatoid arthritis
• Triamcinolone acetonide, which although already used for the treatment of alopecia areata, has never been rigorously tested. They will also test the immunological changes associated with the drug.^{[15][full citation needed]}

See also[edit]

• Alopecia totalis
• Alopecia universalis
• Noncicatricial alopecia
• Locks of Love
• Trichotillomania

References[edit]

1. Jump up ^ Odom, Richard B.; Davidsohn, Israel; James, William D.; Henry, John Bernard; Berger, Timothy G.; Clinical diagnosis by laboratory methods; Dirk M. Elston (2006). Andrews' diseases of the skin: clinical dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. ^{[page needed]}
2. ^ Jump up to: ^{a b c d e f g h i j} Zoe Diana Draelos (August 30, 2007), Alopecia Areata. MedicineNet.com. Retrieved on December 2, 2007
3. Jump up ^ McElwee, Kevin J.; Boggess, Dawnalyn; Olivry, Thierry; Oliver, Roy F.; Whiting, David; Tobin, Desmond J.; Bystryn, Jean-Claude; King, Jr., Lloyd E.; Sundberg, John P. (1998). "Comparison of Alopecia areata in Human and Nonhuman Mammalian Species". Pathobiology 66 (2): 90–107. doi:10.1159/000028002. PMID 9645633. 
4. Jump up ^ Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. ISBN 1-4160-3185-5.^{[page needed]}
5. ^ Jump up to: ^{a b} Skin Conditions: Alopecia Areata. WebMD. Retrieved on December 2, 2007.
6. Jump up ^ Freedberg, Irwin M.; Fitzpatrick, Thomas B. (2003). Fitzpatrick's dermatology in medicine. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-138076-0. ^{[page needed]}
7. ^ Jump up to: ^{a b c d e f} Alopecia Areata at Merck Manual of Diagnosis and Therapy Professional Edition
8. ^ Jump up to: ^{a b c} American Osteopathic College of Dermatology. Alopecia Areata. Dermatologic Disease Database. Aocd.org. Retrieved on December 3, 2007.
9. Jump up ^ Wasserman, Dan; Guzman-Sanchez, Daniela Araucaria; Scott, Kimberly; McMichael, Amy (2007). "Alopecia areata". International Journal of Dermatology 46 (2): 121–31. doi:10.1111/j.1365-4632.2007.03193.x. PMID 17269961. 
10. Jump up ^ Rudnicka, Lidia; Olszewska, Malgorzata; Rakowska, Adriana; Kowalska-Oledzka, Elzbieta; Slowinska, Monika (2008). "Trichoscopy: A new method for diagnosing hair loss". Journal of drugs in dermatology 7 (7): 651–4. PMID 18664157. 
11. Jump up ^ Martinez-Mir, Amalia; Zlotogorski, Abraham; Gordon, Derek; Petukhova, Lynn; Mo, Jianhong; Gilliam, T. Conrad; Londono, Douglas; Haynes, Chad; Ott, Jurg; Hordinsky, Maria; Nanova, Krassimira; Norris, David; Price, Vera; Duvic, Madeleine; Christiano, Angela M. (2007). "Genomewide Scan for Linkage Reveals Evidence of Several Susceptibility Loci for Alopecia Areata". The American Journal of Human Genetics 80 (2): 316–28. doi:10.1086/511442. PMC 1785354. PMID 17236136. 
12. Jump up ^ Duncan, F Jason; Silva, Kathleen A; Johnson, Charles J; King, Benjamin L; Szatkiewicz, Jin P; Kamdar, Sonya P; Ong, David E; Napoli, Joseph L; Wang, Jinshan; King, Lloyd E; Whiting, David A; McElwee, Kevin J; Sundberg, John P; Everts, Helen B (2012). "Endogenous Retinoids in the Pathogenesis of Alopecia Areata". Journal of Investigative Dermatology 133 (2): 334–43. doi:10.1038/jid.2012.344. PMC 3546144. PMID 23014334. 
13. Jump up ^ Petukhova, Lynn; Duvic, Madeleine; Hordinsky, Maria; Norris, David; Price, Vera; Shimomura, Yutaka; Kim, Hyunmi; Singh, Pallavi; Lee, Annette; Chen, Wei V.; Meyer, Katja C.; Paus, Ralf; Jahoda, Colin A. B.; Amos, Christopher I.; Gregersen, Peter K.; Christiano, Angela M. (2010). "Genome-wide association study in alopecia areata implicates both innate and adaptive immunity". Nature 466 (7302): 113–7. Bibcode:2010Natur.466..113P. doi:10.1038/nature09114. PMC 2921172. PMID 20596022. 
14. Jump up ^ Safavi, Kayvon H.; Muller, Sigfrid A.; Suman, Vera J.; Moshell, Alan N.; Melton, L. Joseph (1995). "Incidence of Alopecia Areata in Olmsted County, Minnesota, 1975 Through 1989". Mayo Clinic Proceedings 70 (7): 628–33. doi:10.4065/70.7.628. PMID 7791384. 
15. Jump up ^ Columbia university medical center newsletter^{[verification needed]}

External links[edit]

Wikimedia Commons has media related to Alopecia areata.

• National Institute of Arthritis and Musculoskeletal and Skin Diseases at NIH
• DermAtlas 42

• National Alopecia Areata Foundation
• Canadian Alopecia Areata Foundation

[show] v t e Human hair List of hairstyles / facial hairstyles Classification by type Lanugo Androgenic Terminal Vellus by location Head Nose Ear Eyebrow Eyelash Underarm Chest Abdominal Pubic Leg Hairstyles Afro Afro-textured hair Asymmetric cut Bangs Beehive Big hair Blowout Blunt hair Bob cut Bouffant Bowl cut Braid or Plait Brush cut Bun (odango) Bunches Burr Businessman cut Butch cut Buzz cut Caesar cut Chignon Chonmage Chupryna Comb over Conk Cornrows Crew cut Crochet braids Cropped hair Croydon facelift Curtained hair Devilock Dice Bob Dido flip Digital perm Dreadlocks Duck's ass Emo Extensions Fade Fauxhawk Feathered hair Finger wave Flattop Flipped hair Fontange French braid French twist Bangs (fringe) Full crown Half crown Harvard clip High and tight Highlights Hime cut Historical Christian hairstyles Hi-top fade Induction cut Ivy League Jewfro Jheri curl Kiss curl Layered hair Liberty spikes Long hair Marcelling Mod cut Mohawk Mop-top Mullet 1950s 1980s Pageboy Part Perm Pigtail Pixie cut Pompadour Ponytail Princeton Professional cut Queue Quiff Rattail Razor cut Regular haircut Regular taper cut Ringlets Shag Shape-Up Short back and sides Short brush cut Short hair Spiky hair Standard haircut Surfer hair Taper cut Tonsure Updo Waves Weave Wings Facial hair Beard Chin curtain Chinstrap Designer stubble Goatee Moustache Fu Manchu handlebar horseshoe pencil toothbrush walrus Neckbeard Shenandoah Sideburns Soul patch Van Dyke Hair loss Cosmetic Removal waxing threading plucking chemical electric laser IPL Shaving head leg Razor safety straight other Alopecia areata totalis universalis Androgenic alopecia Glabrousness Hypertrichosis Management Trichophilia Trichotillomania Pogonophobia Related topics Backcombing Bearded lady Barber (pole) Hairdresser Hairstyle Hair color / coloring Hair crimping Hair fetishism (pubic) Hair growth Hair length Hair straightening

[show] v t e Diseases of the skin and appendages by morphology Growths Epidermal wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous-cell carcinoma basal-cell carcinoma Merkel-cell carcinoma nevus sebaceous trichoepithelioma Pigmented Freckles lentigo melasma nevus melanoma Dermal and subcutaneous epidermal inclusion cyst hemangioma dermatofibroma (benign fibrous histiocytoma) keloid lipoma neurofibroma xanthoma Kaposi's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst Rashes With epidermal involvement Eczematous contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott–Aldrich syndrome Zinc deficiency Scaling psoriasis tinea (corporis cruris pedis manuum faciei) pityriasis rosea secondary syphilis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis Blistering herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex Papular scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta Pustular acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis Hypopigmented tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides Without epidermal involvement Red Blanchable Erythema Generalized drug eruptions viral exanthems toxic erythema systemic lupus erythematosus Localized cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption Specialized urticaria erythema (multiforme migrans gyratum repens annulare centrifugum ab igne) Nonblanchable Purpura Macular thrombocytopenic purpura actinic/solar purpura Papular disseminated intravascular coagulation vasculitis Indurated scleroderma/morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica Miscellaneous disorders Ulcers Hair telogen effluvium androgenic alopecia trichotillomania alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae Nail onychomycosis psoriasis paronychia ingrown nail Mucous membrane Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous-cell carcinoma v t e Index of skin Description Anatomy Physiology connective tissue Development Disease Infections by morphology Vesiculobullous Dermatitis and eczema factitial Papulosquamous Urticaria and erythema Radiation-related Pigmentation Mucinoses Keratosis, ulcer, atrophy, and necrobiosis Vasculitis Fat Neutrophilic and eosinophilic Congenital Neoplasms and cancer nevi and melanomas epidermis dermis Symptoms and signs Terminology Treatment Procedures Drugs antibiotics disinfectants emollients and protectives itch psoriasis other Wound and ulcer

[show] v t e Disorders of skin appendages (L60–L75, 703–706) Nail thickness: Onychogryphosis Onychauxis color: Beau's lines Yellow nail syndrome Leukonychia Azure Lunula shape: Koilonychia Nail clubbing behavior: Onychotillomania Onychophagia other: Ingrown nail Anonychia ungrouped: Paronychia Acute Chronic Chevron nail Congenital onychodysplasia of the index fingers Green nails Half and half nails Hangnail Hapalonychia Hook nail Ingrown nail Lichen planus of the nails Longitudinal erythronychia Malalignment of the nail plate Median nail dystrophy Mees' lines Melanonychia Muehrcke's lines Nail–patella syndrome Onychoatrophy Onycholysis Onychomadesis Onychomatricoma Onychomycosis Onychophosis Onychoptosis defluvium Onychorrhexis Onychoschizia Platonychia Pincer nails Plummer's nail Psoriatic nails Pterygium inversum unguis Pterygium unguis Purpura of the nail bed Racquet nail Red lunulae Shell nail syndrome Splinter hemorrhage Spotted lunulae Staining of the nail plate Stippled nails Subungual hematoma Terry's nails Twenty-nail dystrophy Hair Hair loss/ Baldness noncicatricial alopecia: Alopecia areata totalis universalis Ophiasis Androgenic alopecia (male-pattern baldness) Hypotrichosis Telogen effluvium Traction alopecia Lichen planopilaris Trichorrhexis nodosa Alopecia neoplastica Anagen effluvium Alopecia mucinosa cicatricial alopecia: Pseudopelade of Brocq Central centrifugal cicatricial alopecia Pressure alopecia Traumatic alopecia Tumor alopecia Hot comb alopecia Perifolliculitis capitis abscedens et suffodiens Graham-Little syndrome Folliculitis decalvans ungrouped: Triangular alopecia Frontal fibrosing alopecia Marie Unna hereditary hypotrichosis Hypertrichosis Hirsutism Acquired localised generalised patterned Congenital generalised localised X-linked Prepubertal Acneiform eruption Acne Acne vulgaris Acne conglobata Acne miliaris necrotica Tropical acne Infantile acne/Neonatal acne Excoriated acne Acne fulminans Acne medicamentosa (e.g., steroid acne) Halogen acne Iododerma Bromoderma Chloracne Oil acne Tar acne Acne cosmetica Occupational acne Acne aestivalis Acne keloidalis nuchae Acne mechanica Acne with facial edema Pomade acne Acne necrotica Blackhead Lupus miliaris disseminatus faciei Rosacea Perioral dermatitis Granulomatous perioral dermatitis Phymatous rosacea Rhinophyma Blepharophyma Gnathophyma Metophyma Otophyma Papulopustular rosacea Lupoid rosacea Erythrotelangiectatic rosacea Glandular rosacea Gram-negative rosacea Steroid rosacea Ocular rosacea Persistent edema of rosacea Rosacea conglobata variants Periorificial dermatitis Pyoderma faciale Ungrouped Granulomatous facial dermatitis Idiopathic facial aseptic granuloma Periorbital dermatitis SAPHO syndrome Follicular cysts "Sebaceous cyst" Epidermoid cyst Trichilemmal cyst Steatocystoma simplex multiplex Milia Inflammation Folliculitis Folliculitis nares perforans Tufted folliculitis Pseudofolliculitis barbae Hidradenitis Hidradenitis suppurativa Recurrent palmoplantar hidradenitis Neutrophilic eccrine hidradenitis Ungrouped Acrokeratosis paraneoplastica of Bazex Acroosteolysis Bubble hair deformity Disseminate and recurrent infundibulofolliculitis Erosive pustular dermatitis of the scalp Erythromelanosis follicularis faciei et colli Hair casts Hair follicle nevus Intermittent hair–follicle dystrophy Keratosis pilaris atropicans Kinking hair Koenen's tumor Lichen planopilaris Lichen spinulosus Loose anagen syndrome Menkes kinky hair syndrome Monilethrix Parakeratosis pustulosa Pili (Pili annulati Pili bifurcati Pili multigemini Pili pseudoannulati Pili torti) Pityriasis amiantacea Plica neuropathica Poliosis Rubinstein–Taybi syndrome Setleis syndrome Traumatic anserine folliculosis Trichomegaly Trichomycosis axillaris Trichorrhexis (Trichorrhexis invaginata Trichorrhexis nodosa) Trichostasis spinulosa Uncombable hair syndrome Wooly hair Wooly hair nevus Sweat glands Eccrine Miliaria Colloid milium Miliaria crystalline Miliaria profunda Miliaria pustulosa Miliaria rubra Occlusion miliaria Postmiliarial hypohidrosis Granulosis rubra nasi Ross’ syndrome Anhidrosis Hyperhidrosis Generalized Gustatory Palmoplantar Apocrine Body odor Chromhidrosis Fox–Fordyce disease Sebaceous Sebaceous hyperplasia v t e Index of skin appendages Description Anatomy Physiology Development Disease Congenital Neoplasms and cancer Other Symptoms and signs Treatment Procedures Acne drugs

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