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Alopecia areata

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Overview

Alopecia areata (AA) is a common (1-2% of the US population), non-scarring form of hair loss, usually detected on the scalp but may occur on any part of the body including beard, eyebrows, and eyelashes.  The onset may occur rapidly - even overnight - or may develop more insidiously.  Usually, one or several circular, coin-sized patches of complete hair loss appear on the skin. Symptoms, such as mild itching or tingling, are sometime present but skin color change or scale formation is not seen. Lesions can develop a particular size/shape and persistent for an extended period of time before resolution or progression to involve larger areas.  AA may occur at any age in life, but an earlier onset typically portends a more difficult to treat nature and higher risk of recurrence later in life. Most people who develop AA at a young age will develop another episode as some point in their lives, often in the same location as the initial presentation.  

 

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Several subtypes of alopecia areata are recognized by the pattern/distribution of hair loss.  Patchy hair loss on the body or involving less than 50% of the scalp is typically referred to alopecia areata, the most common type. The patches represent areas where a cluster of immune cells are attacking hair follicles (see below).  A minority of patients (approximately 1 in 20) develop larger affected patches of hair loss such as the entire scalp (alopecia totalis; AT) or progress to complete hair loss on the body (alopecia universalis; AU).  Hair loss of the eyelashes and nasal hair can be problematic for protecting against floating debris.  

Less common are AA subtype occurring in band-like distributions of either the posterior hairline (ophiasis pattern) or the frontal hairline (sisaihpo; ophiasis spelled backwards). Development of either of these patterns is a negative prognostic factor - that is, these cases may be harder recover from and may need to be treated more aggressively.  The fact that these pattern exist is a clue that the hairs in these areas, while appearing similar to adjacent hairs on other parts of the scalp, area actually biologically distinct and recognized differently by the immune system.  Nail pitting, in the from of small dents in the fingernails/toenails, is another hallmark of AA and a diagnostic clue that can help distinguish from other types of hair loss.

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