Alopecia areata

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Epidemiology

Alopecia areata generally concerns pupils or students although the prevalence among schoolchildren in Africa was less than 1%.[1][2][3][4] The life-time risk of alopecia areata in the general population is approximately 1.7%. and in as many as 60% of patients the disease starts before the age of 20 years.[5] In patients with alopecia areata a considerable amount had episodes before or has a positive family history.[4]

Etiology and pathogenesis

Alopecia areata is an autoimmune disease that presents with nonscarring hairloss.[4] The pathogenesis is not completely clear.[6][7]Atopy, autoimmune thyroid disease, a positive family history and vitiligo are commonly associated. The course of the disease is unpredictable. Early and severe cases which last long have a less favorable prognosis.[8]

Clinical findings

Alopecia areata most commonly manifests as sudden loss of hair in a well demarcated, localized area in the scalp. The hair loss is usually limited to a single patch. The lesion is usually round or oval. "Exclamation point hairs" are frequently seen at the periphery of the lesion.[5] The majority of patients present with limited alopecia. Approximately 80% present with one patch, about 12% with multiple patches on the scalp and possibly also in the eyebrows, lashes, and beard area, and about 7 % develop total baldness of the scalp (alopecia totalis), some even of all body hair (alopecia universalis).[9]The clinical diagnosis is made by the aspect of hairless patches with a normal skin.

Differential diagnosis

Differential diagnosis[3][8][10]

Management

Management[5][11]

  • Because of the high rate of spontaneous recovery a "watch-and-see" approach is often recommended.
  • Psychological support may be offered if necessary.
  • For patients who actively desire treatment, topical or intralesional corticosteroids are the treatments of choice. Betamethasone dipropionate lotion 0.05% can be applied 2 times daily for 12 weeks or betamethason cream 2 times daily for 1-2 months. If there is no improvement after 12 weeks the treatment should be stopped. Intralesional corticosteroids are appropriate for older children. Triamcinolon acetonide 10 mg/ml diluted with 2% lidocaine with epinephrine (to reduce the pain with the injections) can be injected intradermal once monthly and not longer than 6 months.
  • Topical sensitizers like Anthralin (Dithranol) can be used in concentrations of 0.25-1% cream. Anthralin cream may be applied overnight, initially for 30 minutes and gradually to 1 hour. If there is no result it can be stopped after 3 months. Another possibility is the treatment with diphenylcyclopropenone (DPCP) but this is usually done under the supervision of a dermatologist.
  • Ultraviolet A phototherapy (PUVA) is another option for which the patient has to be referred to a dermatologist.

Photos

Literature

  1. Hogewoning AA, et al. Skindiseases among schoolchildren in Ghana,Gabon and Rwanda. August 2012; accepted for publication in the International Journal of Dermatology
  2. Komba EV, Mgonda YM. The spectrum of dermatological disorders among primary school children in Dar es Salaam. BMC Public Health 2010; 10: 765.
  3. 3.0 3.1 Traore A, Sawadogo S, Barro F et al. Alopecia in consultations in the dermatology department at Burkina Faso: epidemiologic, clinical, and etiologic aspects. Int J Dermatol 2007; 46 Suppl 1: 30-1.
  4. 4.0 4.1 4.2 Xiao FL, Yang S, Liu JB et al. The epidemiology of childhood alopecia areata in China: a study of 226 patients. Pediatr Dermatol 2006; 23: 13-8.
  5. 5.0 5.1 5.2 Hon KL, Leung AK. Alopecia areata. Recent Pat Inflamm Allergy Drug Discov 2011; 5: 98-107.
  6. Alkhalifah A, Alsantali A, Wang E et al. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol 2010; 62: 177-88, quiz.
  7. Wasserman D, Guzman-Sanchez DA, Scott K et al. Alopecia areata. Int J Dermatol 2007; 46: 121-31.
  8. 8.0 8.1 Finner AM. Alopecia areata: Clinical presentation, diagnosis, and unusual cases. Dermatol Ther 2011; 24: 348-54.
  9. Ahmed I, Nasreen S, Bhatti R. Alopecia areata in children. J Coll Physicians Surg Pak 2007; 17: 587-90.
  10. Nnoruka EN, Obiagboso I, Maduechesi C. Hair loss in children in South-East Nigeria: common and uncommon cases. Int J Dermatol 2007; 46 Suppl 1: 18-22.
  11. Garg S, Messenger AG. Alopecia areata: evidence-based treatments. Semin Cutan Med Surg 2009; 28: 15-8.
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