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Alopecia Signs and Symptoms
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
- Clinical forms:
- Patch alopecia areata: Circumscribed areas of alopecia (patches), which may be oval, rounded, single, or multiple
- Total alopecia areata (alopecia totalis): 100% loss of scalp hair
- Universal alopecia areata (alopecia universalis): 100% loss of hair on scalp and body
- Diffuse alopecia areata: Hair loss resulting in overall decrease in density and distributed all over the scalp, without patches
- Acute diffuse and total alopecia: Acute onset of diffuse hair loss, usually progressing to total alopecia areata within 3 months
- Most patients are <40 years of age
