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Introduction
- May be localized (patchy) or generalized
- Scarring or non-scarring
- Scarring alopecia from severe inflammation of the hair follicle result in irreversible damage
- Non-scarring alopecias are reversible
- Abrupt or gradual onset
- Most common causes include androgenic/androgenetic alopecia (male and female pattern baldness) and alopecia areata
- History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness and stress factor
Definition
Alopecia areata
- Autoimmune hair follicle disease characterized by patches of significant hair loss
- A chronic follicular disorder characterized by progressive hair loss with a patterned distribution
- Alopecia totalis mimics androgenic alopecia
Signs and Symptoms
Androgenic alopecia in males/females
Patterned hair loss
Clinical presentation
Patterned hair loss
- Hamilton-Norwood staging [male pattern hair loss (MPHL)]
- The higher the stage, the more severe the hair loss
- Usually starts with bitemporal recession of frontal hairline and continuing with thinning over the vertex, eventually complete hair loss on the vertex; bald hair
- The bald patch enlarges and joins the receding frontal hairline
- Other patterns may develop, but it is the androgenic-independent hair (on the sides and back of scalp) that do not thin
- Ludwig staging [(female pattern hair loss (FPHL)]
- Marked presence of miniaturized, vellus-like hair follicles
- The higher the stage, the more severe the hair loss
- Thinning usually diffuse, but more marked on the frontal and parietal regions; “monk’s haircut” in severe cases
- Christmas Tree Pattern
- Another female hair loss pattern with centroparietal thinning and frontal accentuation
- Thinning of the hair begins between 12-40 years for MPHL
- Chronic progressive diffuse hair loss in their 20’s and 30’s for FPHL
Clinical presentation
- Non-scarring with hairs located at the periphery of the patch extending a few millimeters above the scalp (“exclamation mark”) hair
- Nail dystrophy occurs in 10%
- Pitting with irregular pattern or organized transverse or longitudinal rows, concave dorsal nail plate, etc
- 100% loss of scalp hair (alopecia totalis), 100% loss of hair on scalp and body (alopecia universalis)
- Most patients are <40 years of age
