​Dermatology - Alopecia Areata

​Dermatology - Alopecia Areata
Alopecia areata refers to the specific loss of hair in circular or oval-shaped patches without any visible skin irritation. The procedure is non-scarring and preserves the integrity of the hair follicle, allowing for potential regeneration. Alopecia areata can be linked to autoimmune disorders. The age at which symptoms first appear is often during early adulthood, however it is possible for them to manifest at any stage of life.
Alopecia is a progressive condition characterized by stable patches of hair loss that may exhibit spontaneous recovery over several months. While some patches resolve, new ones may emerge.
Patients commonly experience significant distress regarding hair loss and the possibility of ongoing, gradual baldness. There is a possibility of some redness in the area where hair loss has occurred.
Lesions characterized by the presence of "exclamation mark" hairs are observed along the edges of places where hair loss has occurred, serving as a diagnostic feature.
These are truncated hairs with wider ends at the distal end compared to the proximal end. Alopecia can manifest as either isolated patches or as a complete absence of hair on the scalp, or as a widespread loss of hair on the body (including fine vellus hair). Scalp diffuse alopecia areata causes the hair to appear thinner and can be challenging to distinguish from pattern hair loss of telogen effluvium or hair loss due to thyroid disease. During the process of hair regrowth, the newly grown hairs tend to be thin and frequently appear white or gray in color.


The diagnosis is made based on clinical examination, while laboratory tests are done to exclude the possibility of lupus, syphilis, and tinea capitis. The differential diagnosis comprises white-patch tinea capitis, trichotillomania, early scarring alopecia, pattern hair loss, and secondary syphilis (alopecia areolaris) which presents as a "moth-eaten" appearance in the beard or scalp.

The treatment focuses on reducing the inflammatory infiltrate and inhibiting the growth factors produced by inflammation. However, there is presently no medication that can completely cure the condition. Psychological assistance from the dermatologist, family, and support groups is often the crucial role in managing the patient. While topical glucocorticoids are often ineffective, intralesional glucocorticoids provide brief effectiveness, and systemic glucocorticoids can stimulate regrowth, albeit momentarily, with associated long-term dangers.