Alopecia areata is a non-scarring condition characterized by round or oval patches of hair loss with a generally good prognosis for limited cases. The etiology remains unknown but is associated with autoimmune diseases, and management options include intralesional steroids. Diagnosis may involve lab tests and histopathology, while psychological support and various therapies offer symptom relief but no cure.

1. Alopecia Areata Abdullatif Sami Al Rashed
Dermatology block 5.5
College of medicine, King Fiasal University
Al Ahsa, Saudi Arabia

3. Introduction
 A localized loss of hair in round or oval areas with no
apparent inflammation of the skin.
 Nonscarring; hair follicle intact; hair can regrow.
 Clinical findings: Hair loss ranging from solitary patch to
complete loss of all terminal hair.
 Prognosis: good for limited involvement. Poor for
extensive hair loss.
 Management: intralesional triamcinolone effective for
limited number of lesions.

4. Etiology
 Unknown.
 Association with other autoimmune diseases and
immunophenotyping of lymphocytic infiltrate
around hair bulbs suggests an anti–hair bulb
autoimmune process

5. Age of Onset
 Young adults (<25 years);
 children are affected more frequently.

6. Clinical Manifestations
 Duration of Hair Loss: Gradual over weeks to
months.
 AW: Autoimmune thyroiditis. Down syndrome.
Autoimmune poly-endocrinopathy-candidiasis–
ectodermal dysplasia syndrome.

7. Hair
 Round patched of hair loss. Single or multiple. May
coalesce.
 Alopecia often sharply defined with normal-
appearing skin with follicular openings present.
 Exclamation mark hairs.
 Diagnostic: broken-off stubby hairs (distal ends are
broader than proximal ends)

8. Sites of Predilection
 Scalp most commonly.
 Any hair-bearing area. Beard, eyebrows, eyelashes,
pubic hair.

9. Types
 Alopecia Areta: Solitary or multiple areas of hair
loss
 Alopecia Universalis: Total loss of all terminal body
and scalp hair
 Alopecia Totalis: Total loss of terminal scalp hair.
 Ophiasis: Bandlike pattern of hair loss over
periphery of scalp.

10. Nails
 Fine pitting “Hammered brass” of dorsal nail plate.
 Also: mottled lunula, trachyonychia (rough nails),
onychomadesis (separation of nail from matrix)

11. Differential Diagnosis
 Tenia Capits
 Early scarring alopecia
 Secondary syphilis (Alopecia areolaris  mouth
eaten appearance of the beard)
 Trichotillomania
 Pattern hair loss

12. Lab tests
 Serology.
 ANA (to rule out SLE)
 rapid plasma reagin (RPR) test (to rule out secondary
syphilis).
 KOH Preparation.
 To rule out tinea capitis.
 Histopathology:
 Acute lesions show peribulbar, perivascular, and outer
root sheath mononuclear cell infiltrate of T cells and
macrophages; follicular dystrophy with abnormal
pigmentation and matrix degeneration. May show
increased number of catagen/telogen follicles.

13. Course
 Spontaneous remission more with patchy AA, not
with AAT or AAU
 Poor prognosis if:
 Late onset
 Fx of AA
 Atopy
 Nail involvement and body hair loss
 High recurrence

14. Management
 No curative TTT
 Psychological support
 Steroids (interlesional or systemic)
 Cyclosporin
 Oral PUVA (Photochemotherapy).
 Induction of Allergic Contact Dermatitis:
 Dinitrochlorobenzene, squaric acid dibutylester, or
diphencyprone
 Causes local discomfort due to allergic contact dermatitis
and swelling of regional lymph nodesposes a problem.

15. Reference

16. ThankYou 