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Is it Necessary to Treat all Cases of Alopecia Areata Hair

Loss?

Alopecia areata occurs most commonly between the ages of 15 and 35 years. One or more, round or
oval smooth patches of hair loss appear on the scalp, eyebrows, beard or other hair bearing areas.
The patches are of varying sizes and shapes. The hairs at the margin of the patches taper towards
the surface, presenting the classical exclamation mark hairs, typical of alopecia areata. These hairs

are weak and can easily be pulled out.


Nails are affected in 1020% of cases and show a regular array of horizontally or perpendicularly
arranged pits on the nail plate. The lunula (the semicircular white mark near the cuticle of the nail)
may show spotty loss of the white color in some patients. In very severe cases, the nails may become
rough and get separated from the matrix.
An increased incidence of other autoimmune diseases, like Hashimotos thyroiditis and vitiligo, are
seen among alopecia areata patients.
What are the Different Clinical Presentations of Alopecia Areata?

Alopecia areata usually presents as single or multiple areas of hair loss, most commonly on the
scalp, and also on other hair bearing areas like the beard, eyebrows, eyelashes, pubic hair and other
body areas.
Alopecia totalis denotes total loss of scalp hair.In alopecia universalis, there is total loss of hair from
the body, including the scalp.Ophiasis: band like hair loss from the scalp margins.Sisaphio or reverse
ophiasis: hair loss limited to the top, center and vertex of the scalp, sparing the margins.Is it
Necessary to Treat All Cases of Alopecia Areata?
Spontaneous regrowth is quite common in alopecia areata. Hence, localized, small patches of hair
loss need not be treated, except for cosmetic purposes. Looking for a local dentist in Des Moines, IA?
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New hair growth, either spontaneous or following treatment. may be sparse and non-pigmented in
many cases. There is no need to worry; full thickness, healthy hairs will grow out within a few
months.
However, if there is extensive, continuous loss of patchy hair loss, a dermatological consultation is
mandatory.

Many patients have associated caries teeth or other dental infections. A dental consultation is also
advisable in recurrent cases of alopecia areata.
What is the Normal Course and Prognosis of Alopecia Areata?
The hair loss in alopecia areata is gradual over weeks to months, though in some individuals the
patches may appear and spread within a span of few days. The bald patches may remain stable and
show slow spontaneous hair growth over a period of several months.
Alopecia areata has an unpredictable course. Treated or untreated, recurrences are quite common in
alopecia areata. New patches may appear elsewhere while hair growth occurs in the existing
patches.
Eighty percent of those getting alopecia areata after puberty can expect regrowth of the hair with or
without treatment. However, in extensive alopecia areata and the totalis and universalis varieties,
only less than 10% get spontaneous regrowth. For this reason, these patients should receive
aggressive therapeutic intervention.
Resistance to treatment and poor prognosis is evident in the following situations.
Early age of onset: childhood alopecia areata is often difficult to treat.Extensive alopecia, total
alopecia and alopecia universalis portend poor prognosis.Family history of alopecia and history of
atopy or allergic tendencies in the individual or among close relatives.Nail involvement indicates
higher levels of auto-antibodies and poor prognosis.What are the Laboratory Investigations to be
Carried Out in Cases of Alopecia Areata?
In localized patchy hair loss, the clinical appearance is sufficient to make a diagnosis. However, in
recurrent cases or patients presenting with extensive alopecia areata, certain laboratory
investigations are mandatory.
Complete blood counts with erythrocyte sedimentation rate(ESR): to rule out any concurrent
systemic infections or blood disorders.Thyroid function tests are necessary to rule out concomitant
thyroid problems.T and B lymphocyte estimation to assess the levels of auto-antibodies against the
hair follicles.Biopsy and histopathological examination of the alopecia patch is indicated for research
purposes only. Bee swarm-like clusters of lymphocytes around the hair follicles is typical in alopecia
areata. Otherwise, the epidermis and dermis are normal.In recurrent cases, an antinuclear antibody
test to rule out systemic lupus erythematosus, an RPR test to rule out syphilis and a KOH
preparation to rule out fungal infections are also mandatory to exclude other major patchy hair loss
causes.
Alopecia areata, when extensive and recurrent, can cause intense anxiety and stress in affected
individuals. It is necessary to provide emotional support to the patient both at home and in the
dermatology consultation. Reassurance is necessary and the chances of spontaneous recovery
should be stressed. It cosmetic dentist los angeles des moines also necessary to look out for all the
implicated causes of patchy hair loss in alopecia areata. Once these are ruled out or tackled if
present, in an initial attack of alopecia areata with small, limited number of patches, the patient
should be offered the option of not taking any treatment at all. Wait and watch is the best policy in
such cases.
Further Reading What are the Causes of Reversible Patchy Hair Loss? Causes of Irreversible
Scarring Type of Patchy Loss of Hair, Scarring Type of Patchy Loss of Hair How to Get Rid of the

Patchy Hair Loss in Alopecia Areata?Treatment of Alopecia areata: National Alopecia Areata
FoundationSourceRalf P, Elis AO, Andrew GM. Hair Growth Disorders, in Fitzpatricks Dermatology
in General Medicine. 7th Ed, 1: 753-777, 2008Messenger AG. Alopecia areata, in Rooks Text Book of
Dermatology, 8th Ed, 4: 66.31-66.38, 2010Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the
options available. No diagnosis should be made or treatment undertaken without first consulting
your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The
images provided are for illustration purpose only.
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