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Patchy Hair Loss Explained
- 1. Rapid and complete loss of hair in one or more round or oval patches on scalp, beard area, eye brows, eye lashes, or (less commonly) rest of the body.
- 2. Unknown, Autoimmune (cell mediated immunity) peribulbar inflammatory cell infiltrate • in active state: helper T-cell predominate (cluster like bee swarm) • in regrowth state: suppressor T-cell hyperfunction Genetic factor: HLA class II (¼ of patients have positive family history) • associated HLA-DR4, DR11, and QD7 early onset, severe, and familiar • in non-associated later onset, milder, better prognosis, and less family involvement Early in the disease: T-helper cells aggregate @ peribulbar of anagen and early catagen follicle, makes hair in abnormal catagen phase persistent telogen. Hair follicle moves up into dermis and remain there.
- 3. Uninflamed non-scaly, empty hair follicle patch(es) of 1-5cm in diameter • some resting hairs may be found within the lesion • in early cases gray hairs may be spared • at lesion periphery, hair may be broken off ~4mm from the scalp with attenuated bulb, narrower and less pigmented proximally (exclamation point hair) pathognomonic sign • In 1st attack, regrowth is usual within a few months of new hair at the lesion center (fine & pale normal color and thickness) in older patients hair remain white. • If relapse occurs heals slower • Sometimes complicates into a. totalis or universalis. • Associated with atopy: atopic dermatitis, Down syndrome, lichen planus, SLE, thyroiditis, myasthenia gravis, and vitilligo. • 10% nail involvement (uniform pits form 1 or more lines)
- 4. • Tinea capitis • Early lupus erythematosus • Secondary syphilis • Congenital triangular alopecia • Alopecia neoplastica • Trichotillomania
- 6. 17 years old male developed smooth shiny patches of complete scalp hair loss and depigmented finger tip macules http://162.129.70.33/images/vitiligo_alopeci a_areata_3_080318.jpg
- 7. 38 years old female developed 4 cm patch of complete hair loss http://162.129.70.33/thumbnails/Alopecia_ Areata_1_080326.jpg
- 8. 35 years old male with well demarcated round 1 cm and 4 cm patches of hair loss Comments: well circumscribed areas of non-scarring alopecia for 2 months. Exclamation point hairs are visible at the periphery of the lesions. http://162.129.70.33/thumbnails/Alopecia_ areata_1_080114.jpg
- 9. 5 cm diameter patch of complete hair loss This 40-year-old woman complained of a hairless patch on the mid scalp for 8 weeks. A laboratory evaluation revealed subclinical hyperthyroidism. http://162.129.70.33/thumbnails/Alopecia_ areata_1_070121.jpg
- 17. http://www.globalskinatlas.com/upload/lg838_1.jpg History: 27 years old male with 3 months ago started noticing hair loss from left temporal area. Actual lesion is a 5.5 cm alopecic area without atrophy of the skin.
- 20. Inform the patient: either resolves spontaneously with few weeks, other cases resist all forms of treatment. • Steroid intralesional injection (localized and cosmetic indication) repeated every 6 weeks • Steroid cream applied for wider lesions • If no response: topical anthralin 1% cream 15-20min then washed off • Minoxidil application trial • For extensive cases: induction with squaric acid dibutyl ester, dinitrochlorobenzene, diphencyprone, methoxsalen, and UVA • For rapidly progressing lesions: prednisolone
- 21. Poor prognostic factors: • Associated with atopic dermatitis • Childhood onset • Wide spread involvement • Opiasis • >5 years duration • Associated with nail involvement (onychodystrophy)