1. ALOPECIA AREATA
Bahar PEZÜKLİ

2. CONTENTS Introduction Epidemiology Patogenesis Clinical features
Associated diseases
Diagnosis
Differential diagnosis
Treatment
Prognasis

3. Alopekia (in Greek); hair loss
Alopecia areata is a non-cicatricial (non-scarring) alopecia that is postulated to be a hair-specific autoimmune disease, with genetic factors involved in disease susceptibility and severity
Involvement sites:
Scalp %
Beard - 28% of males
Eyebrows - 3.8%
Extremities - 1.3%

4. EPIDEMIOLOGY < 25 years
Sixty percent of patients present with their first patch before 20 years of age
F/ M :1/1
All races effected equally.

5. PATOGENESIS
T-lymphocyte interaction with follicular antigens (autoantigens) has been implicated in alopecia areata.
In immunofluorescence, antibodies to anagen-phase hair follicles were found.

6. CLINICAL FEATURES
It commonly seen as oval or round patches and sharply defined.
There is nonscarring hair loss.
“Exclamation point” hair
can be seen.

7. Hair Presentations; Alopecia totalis; loss of all scalp hair.
Alopecia universalis; loss of all scalp
and body hair.
Some patients
complain of itching, tenderness, or a burning sensation
before the patches appear.
Ophiasis pattern; band- like pattern
of hair loss over periphery of
temporal and occipital scalp.

9. Nails Most common sign is pitting.
trachyonychia (sandpapered nails)(longitudinal striations)
Mottled lunula, brittle nails, onycholysis.

10. ASSOCIATED DISEASES -Associated diseases:
Atopy (allergic rhinitis, atopic dermatitis, asthma)
Autoimmune thyroid disease(e .g . Hashimoto’s thyroiditis), vitiligo,
Inflammatory bowel disease
Autoimmune polyendocrinopathy syndrome type 1  (autosomal recessive)
Type 1 diabetes increased in relatives of patients with alopecia areata
-HLA associations

11. DIAGNOSIS
History and physical examination
ANA, RPR

12. DIFFERENTIAL DIAGNOSIS
Tinea capitis
Secondary syphillis
Trichotillomania (short and broken hairs)
Traction alopecia
Telogen effluvium (Hair loss occurs over the entire scalp with telogen effluvium)

13. TREATMENT Because of unpredictable course, treatment is difficult.
Treatments control but do not cure and do not prevent the spread of AA. Treatments according to age and severity
Glucocorticoids; topical, intralesional, systemic.
Minoxidil ( Minoksil, Rogain)
Anthralin

15. Prognosis
The course is unpredictable; recovery may be complete or partial. Several episodes of loss and regrowth are typical. The prognosis for total permanent regrowth in cases with limited involvement is excellent.
Most patients entirely regrow hair within 1 year without treatment; 10% develop chronic disease and may never regrow hair.
Patients with a family history of AA, young age at onset, immune diseases, nail dystrophy, atopy, and extensive hair loss have a poor prognosis.

16. REFERENCES Dermatology, Jean L Bolognia, Chapter 69
Clinical Dermatology,Thomas P. Habif, Chapter 24

17. THANK YOU…