Alopecia areata (alopecia – baldness, area –patchy spot) (AA) is the sudden loss of hair or hair in the patchy spots, in people without established cutaneous or systemic disease. Very often called patchy hair loss.
Most often it affects hair and beard, but any area of the body may be affected by. This circular focal point of alopecia can be in one place (AA monolocularis) or more (AA multilocularis). Changes may occur on the eyebrows, beard, eyelashes and other skin. If the hair loss spreads to the entire scalp, the disease is called alopecia totalis, and if it comes to the whole body including axillary and pubic hair – alopecia universalis. Alopecia areata is considered an autoimmune disease that affects genetically prone persons exposed to an undetermined environmental factors, such as infection, emotional stress, illness, surgery and others. Sometimes appears in association with other autoimmune diseases (vitiligo, autoimmune thyroiditis, etc..).
Diagnosis is made by examination and dermoscopy. A biopsy of the lesion’s edges can be done. Alopecia areata typically looks like a discrete circular areas of hair loss. Dermoscopy, reveals short broken hairs on the edges that seem like an exclamation mark, as well as empty follicular ostia. Differential diagnosis includes other disorders and diseases that can cause alopecia, such as tinea capitis, trichotillomania, discoid lupus and secondary syphilis. Determination of TSH, vitamin B12 and autoantibodies is indicated only when it is suspected to co-existence of other diseases.
Treatment of alopecia areata is uncertain and complex. The smaller focal points can be treated with corticosteroids (oral, injectied or topical). There are reports about the positive effect of PRP therapy for minor lesions. Alopecia totalis can positively respond to higher doses of steroids. Marbo Activator is a product intended for the treatment of alopecia areata and alopecia totalis and after persistent use for many months and shows the effect of new hair growth. Hair transplantation is contraindicated, as a method of treatment because it can lead to the activation of the process, and also transplanted follicles may be exposed to an autoimmune process and be destroyed. Hair transplant can only be done if alopecia areata is stable without spreading lesions and with no appearance of new lesions for a period of 2 years. Alopecia areata can occur after transplantation and is considered as one of the complications. Usually minor lesion, occurs in less than 1% of cases and it is reversible. It occurs commonly in patients who once in their life had already patchy hair loss or have a genetic predisposition to the formation of the same.
Alopecia totalis is a difficult condition to treat, and unfortunately more and more often occurs in children and teenagers. During the testing of a new drug Ruxolitiniba which showed effective in the treatment of conditions associated with diseases such as celiac disease, type 1 diabetes, psoriasis and rheumatoid arthritis. Still in the experimental stage, treatment is quite expensive, but gives hope that they science will find a cure this unpredictable illness.
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An example of alopecia areata which had affected part of an eyebrow and has been successfully treated with several injections of corticosteroids.