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Alopecia Areata

  • Pooya Khan Mohammad Beigi
Chapter

Abstract

Alopecia areata (AA) is a type of non-scarring, patterned alopecia that presents in sharply defined circular areas. AA is an autoimmune disease involving T cells, which results in the immune system mistakenly targeting the body’s own hair follicles, resulting in hair loss [1]. AA is characterized by sudden non-scarring hair loss in the form of round or oval patches with spontaneous remissions and exacerbations [2]. The patches are well circumscribed, and they may have a mild peachy hue, occasionally with “exclamation point” hairs around their margin. “Exclamation point” hairs are broken short hairs with a broader distal segment as compared to the proximal end. The involved skin is usually smooth and almost always totally devoid of hair [3].

Keywords

Autoimmune disease T cells Round patches Oval patches Genetic factors CD-8-driven Th1-type autoimmune reaction Alopecia totalis Alopecia universalis Pigmented hairs Nail changes Nail dystrophy Inner hair sheath Outer hair sheath Dermal papilla Hair bulb Hair bulge Sebaceous gland Arrector pili muscle Stem cells Melanocytic Epithelial Sebaceous glands Interfollicular epithelium Cuticle Cortex Medulla Hair shaft Genetic basis Histocompatibility complex Cytokine Immunoglobulin genes Polygenic disorder Inflammation-induced hair loss Alopecia totalis Alopecia universalis Patchy hair loss Black dots Lack of infection Chronic discoid lupus erythematosus Lichen planopilaris Syphilis Traction alopecia Metastasis to the scalp Mycosis fungoides Alopecia mucinosa Scalp biopsy Telogen effluvium Mild erythema Burning or pruritus Vellus hairs Sisaipho patterns Frontal scalp Temporal scalp Parietal scalp Ophiasis pattern of hair loss Nail involvement Pitting Trachyonychia Onychorrhexis Onycholysis Onychomadesis Atopic dermatitis Psoriasis Vitiligo Lupus erythematosus Thyroid disease Allergic rhinitis Edema Cellular necrosis Pigment incontinence Microvesiculation Tinea capitis Dermatophyte fungi Mild scaliness Inflammatory pustular plaques M. audouinii M. canis T. tonsurans T. violaceum M. audouinii M. canis M. audouinii tonsurans T. violaceum Dihydrotestosterone (DHT) Pull test Congenital triangular alopecia (CTA) Pilosebaceous Cicatricial alopecia Sebaceous glands Inflammatory infiltrate Trichotillomania First-line therapy Intralesional corticosteroids Topical immunotherapy Triamcinolone Doses Side effects Second-line therapies Systemic glucocorticoids Relapse Side effects Refractory cases Children Topical minoxidil Topical immunotherapy 

References

  1. 1.
    Islam N, Leung PS, Huntley AC, Gershwin ME. The autoimmune basis of alopecia areata: a comprehensive review. Autoimmun Rev. 2015;14(2):81–9.CrossRefPubMedGoogle Scholar
  2. 2.
    García-Hernández MJ, Ruiz-Doblado S, Rodriguez-Pichardo A, Camacho F. Alopecia areata, stress and psychiatric disorders: a review. J Dermatol. 1999;26(10):625–32.CrossRefPubMedGoogle Scholar
  3. 3.
    Alkhalifah A, Alsantali A, Wang E, KJ ME, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010;62(2):177–88.CrossRefPubMedGoogle Scholar
  4. 4.
    Gilhar A, Etzioni A, Paus R. Alopecia areata. N Engl J Med. 2012;366(16):1515–25.CrossRefPubMedGoogle Scholar
  5. 5.
    Hordinsky MK. Overview of alopecia areata. J Investig Dermatol Symp Proc. 2013;16(1):S13–5. Elsevier.CrossRefGoogle Scholar
  6. 6.
    Watkins J. Alopecia, part 1: non-scarring forms. Pract Nurs. 2009;20(7):358–63.CrossRefGoogle Scholar
  7. 7.
    Tobin DJ, Fenton DA, Kendall MD. Ultrastructural observations on the hair bulb melanocytes and melanosomes in acute alopecia areata. J Investig Dermatol. 1990;94(6):803–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Wade MS, Sinclair RD. Persistent depigmented regrowth after alopecia areata. J Am Acad Dermatol. 2002;46(4):619–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42(4):549–66.CrossRefPubMedGoogle Scholar
  10. 10.
    Hendren OS. Identical alopecia areata in identical twins. Arch Dermatol Syphilol. 1949;60(5_PART_I):793–5.CrossRefGoogle Scholar
  11. 11.
    Weidman AI, Zion LS, Mamelok AE. Alopecia areata occurring simultaneously in identical twins. AMA Arch Derm. 1956;74(4):424–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Shelton JM, Hollander L. Alopecia Totalis in father and daughter: report of cases. Arch Dermatol Syphilol. 1942;46(1):137–8.CrossRefGoogle Scholar
  13. 13.
    Hordinsky MK, Hallgren H, Nelson D, Filipovich AH. Familial alopecia areata: HLA antigens and autoantibody formation in an American family. Arch Dermatol. 1984;120(4):464–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Valsecchi R, Vicari O, Frigeni A, Foiadelli L, Naldi L, Cainelli T. Familial alopecia areata--genetic susceptibility or coincidence? Acta Derm Venereol. 1984;65(2):175–7.Google Scholar
  15. 15.
    MacDonald Hull S, Wood ML, Hutchinson PE, Sladden M, Messenger AG. Guidelines for the management of alopecia areata. Br J Dermatol. 2003;149(4):692–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Van der Steen P, Traupe H, Happle R, Boezeman J, Sträter R, Hamm H. The genetic risk for alopecia areata in first degree relatives of severely affected patients. An estimate. Acta Derm Venereol. 1992;72(5):373–5.PubMedGoogle Scholar
  17. 17.
    Shellow WV, Edwards JE, Koo JY. Profile of alopecia areata: a questionnaire analysis of patient and family. Int J Dermatol. 1992;31(3):186–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Colombe BW, Lou CD, Price VH. The genetic basis of alopecia areata: HLA associations with patchy alopecia areata versus alopecia totalis and alopecia universalis. J Investig Dermatol Symp Proc. 1999;4(3):216–9. ElsevierCrossRefPubMedGoogle Scholar
  19. 19.
    Alzolibani A. Epidemiologic and genetic characteristics of alopecia areata (part 1). Acta Dermatoven APA. 2011;20(4):191–8.Google Scholar
  20. 20.
    Walker SA, Rothman S. Alopecia Areata1: a statistical study and consideration of endocrine influences. J Investig Dermatol. 1950;14(6):403–13.CrossRefPubMedGoogle Scholar
  21. 21.
    Molin L. Aspects of the natural history of herpes zoster. A follow-up investigation of outpatient material. Acta Dermato Venereologica. 1969;49(6):569–83.PubMedGoogle Scholar
  22. 22.
    Chartier MB, Hoss DM, Grant-Kels JM. Approach to the adult female patient with diffuse nonscarring alopecia. J Am Acad Dermatol. 2002;47(6):809–18.CrossRefPubMedGoogle Scholar
  23. 23.
    Mun̄oz MA, Camacho FM. Sisaipho: a new form of presentation of alopecia areata. Arch Dermatol. 1996;132(10):1255–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Kasumagic-Halilovic E, Prohic A. Nail changes in alopecia areata: frequency and clinical presentation. J Eur Acad Dermatol Venereol. 2009;23(2):240–1.CrossRefPubMedGoogle Scholar
  25. 25.
    Chu S-Y, Chen Y-J, Tseng W-C, Lin M-W, Chen T-J, Hwang C-Y, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011;65(5):949–56.CrossRefPubMedGoogle Scholar
  26. 26.
    Hay RJ. Tinea capitis: current status. Mycopathologia. 2017;182(1-2):87–93.CrossRefPubMedGoogle Scholar
  27. 27.
    Varothai S, Bergfeld WF. Androgenetic alopecia: an evidence-based treatment update. Am J Clin Dermatol. 2014;15(3):217–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Mounsey AL, Reed SW. Diagnosing and treating hair loss. Am Fam Physician. 2009;15:80(4).Google Scholar
  29. 29.
    Liyanage D, Sinclair R. Telogen Effluvium. Cosmetics. 2016;3(2):13.CrossRefGoogle Scholar
  30. 30.
    Kudligi C, Bhagwat PV, Eshwarrao MS, Tandon N. Giant congenital triangular alopecia mimicking alopecia areata. Int J trichology. 2012;4(1):51.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Price V, Mirmirani P, editors. Cicatricial alopecia: an approach to diagnosis and management. New York: Springer Science & Business Media; 2011.Google Scholar
  32. 32.
    Dogra S, Sarangal R. What's new in cicatricial alopecia. Indian J Dermatol Venereol Leprol. 2013;79(5):576.CrossRefPubMedGoogle Scholar
  33. 33.
    Sah DE, Koo J, Price VH. Trichotillomania. Dermatol Ther. 2008;21(1):13–21.CrossRefPubMedGoogle Scholar
  34. 34.
    Walsh KH, McDougle CJ. Trichotillomania. Am J Clin Dermatol. 2001;2(5):327–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Kalkoff K, Macher E. Growing of hair in alopecia areata & maligna after intracutaneous hydrocortisone injection. Der Hautarzt. Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 1958;9(10):441–51.Google Scholar
  36. 36.
    Porter D, Burton J. A comparison of intra-lesional triaminolone hexa-cetonide and triamcinolone acetonide in alopecia areata. Br J Dermatol. 1971;85(3):272–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Fülöp E, Vajda Z. Experimental studies on therapeutic and adverse effects of intrafocal steroid treatment. Dermatol Monatsschr. 1971;157(4):269–77.PubMedGoogle Scholar
  38. 38.
    Abell E, Munro D. Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector. Br J Dermatol. 1973;88(1):55–60.CrossRefPubMedGoogle Scholar
  39. 39.
    Tosti A, Piraccini BM, Pazzaglia M, Vincenzi C. Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis. J Am Acad Dermatol. 2003;49(1):96–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Tosti A, Bellavista S, Iorizzo M. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol. 2006;55(3):438–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Kamath G. A clinical study of alopecia areata and to evaluate of the efficacy of 0.03% topical tacrolimus in its treatment. Hospital. 2004;2006.Google Scholar
  42. 42.
    Otberg N. Systemic treatment for alopecia areata. Dermatol Ther. 2011;24(3):320–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Harrison S, Sinclair R. Telogeneffluvium. H&G Zeitschrift für Hautkrankheiten. 2002;77(7–8):351–8.CrossRefGoogle Scholar
  44. 44.
    Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the united states. JAMA Dermatology. 2013;149(7):789–94.  https://doi.org/10.1001/jamadermatol.2013.3049.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pooya Khan Mohammad Beigi
    • 1
    • 2
    • 3
  1. 1.Department of Health ManagementNew York Medical CollegeValhallaUSA
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.Misdiagnosis AssociationSeattleUSA

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