Alopecia

Alopecia areata is a condition presenting with symptomless, well circumscribed, smooth, bald patches. It is often noticed by chance by a parent, spouse, hair dresser or a friend. It usually starts on the scalp and may involve beard region or some times the whole body. Progression of the disease is varied. In a few cases, the initial patch of hair loss may re-grow spontaneously within a few months while in others, new areas of hair loss may develop sometimes resulting in total hair loss.

Causes: The exact cause is uncertain, many factors may play a role.

  1. Genetic constitution
  2. Autoimmune origin (organ specific auto immune disease)
  3. Non-specific immune reaction
  4. Atopic state (Those with personal/family history of bronchial asthma, allergic rhinitis)
  5. Emotional stress

Alopecia areata has to be differentiated from other causes of bald patches like trichotillomania (habitual plucking of the hair), following inflammatory type of tinea capitis (fungal infection of scalp) etc. In doubtful cases, biopsy of the patch is indicated.

Treatment:

  1. Glucocorticoids (Topical, intra lesional, oral): In case of a few localised, stable patches, intra-lesional (injection to the site) steroids show beneficial effects. Oral steroids are indicated in the presence of rapidly progressing disease and many patches. Although steroids prevent the progression of the disease, a relapse cannot be prevented. Oral steroids are associated with adverse effects that can be minimised with proper dosing, timing and regular follow-up.
  2. Sensitizers: This type of treatment involves use of chemicals that cause dermatitis at the site of hair loss. The chemicals used include
    1. Dinitrochlorobenzene (DNCB) 2%: Success rate ranges from 10-78%
    2. Squaric acid dibutyl ester (SADBE)
    3. Diphencyprone
    4. Primula obconica

    Dermatitis and the other adverse effects caused by these agents have lead many dermatologists to abandon this treatment

  3. Psoralen and Ultra Violet light A (PUVA): It is beneficial in up to 60% of cases and patients with alopecia totalis and history of atopy respond poorly.
  4. Topical minoxidil: Though it is tried by some, the results are less encouraging.
  5. Cyclosporine (oral), tacrolimus (topical)

The prognosis of this condition depends upon the age of onset (earlier the onset, poorer the prognosis), co-existent history of atopy (atopics more likely to go in for alopecia totalis) and genetic predisposition.

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Alopecia Areata Before Treatment Alopecia Areata After OMP
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Alopecia Areata Before Treatment Alopecia Areata After OMP

 

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