Alopecia areata
169498
226056775
2008-07-16T17:09:39Z
Matharu1
7486739
/* Causes */
{{DiseaseDisorder infobox |
Name = Alopecia areatica montytis |
ICD10 = {{ICD10|L|63||l|60}} |
ICD9 = {{ICD9|704.01}} |
ICDO = |
Image = Alopecia areata head.jpg |
Caption = Severe case of alopecia areata before becoming totalis |
OMIM = 104000 |
MedlinePlus = 001450 |
eMedicineSubj = derm |
eMedicineTopic = 14 |
DiseasesDB = 430 |
MeshID = D000506 |
}}
'''Alopecia areata''' ('''AA''') is a condition affecting humans, in which [[hair loss|hair is lost]] from areas of the body, usually from the [[scalp]].<ref name=draelos>Zoe Diana Draelos ([[August 30]], [[2007]]), [http://www.medicinenet.com/alopecia_areata/article.htm Alopecia Areata]. MedicineNet.com. Retrieved on [[December 2]], [[2007]].</ref> Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called '''spot baldness'''. In 1%–2% of cases, the condition can spread to the entire scalp ([[Alopecia totalis]]) or to the entire [[Epidermis (skin)|epidermis]] ([[Alopecia universalis]]). Conditions resembling AA, and having a similar cause, occur also in other species.<ref>PMID9645633</ref>
==Epidemiology==
The condition affects 1%–2% of humans,<ref name="pmid17673378">{{cite journal |author=Dudda-Subramanya R, Alexis AF, Siu K, Sinha AA |title=Alopecia areata: genetic complexity underlies clinical heterogeneity |journal=European journal of dermatology : EJD |volume=17 |issue=5 |pages=367–74 |year=2007 |pmid=17673378 |doi=10.1684/ejd.2007.0231 |doi_brokendate=2008-06-26}}</ref> occurring in both males and females.<ref name=draelos/>
Alopecia areata occurs in people who are apparently healthy and have no skin disorder.<ref name=merck>[http://www.merck.com/mmpe/sec10/ch124/ch124b.html Alopecia (Baldness)] Merck.com. Retrieved on [[December 2]], [[2007]].</ref> Initial presentation most commonly occurs in the late [[teenage]] years, early childhood, or young adulthood, but can happen with people of all ages.<ref name=draelos/>
==Types==
[[Image:Aloepeciaat2.jpg|thumb|A woman with alopecia areata totalis.]]
The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.<ref name=draelos/>
* Hair may also be lost more diffusely over the whole scalp, in which case the condition is called '''diffuse alopecia areata'''.<ref name=draelos/>
* '''Alopecia areata monolocularis''' describes baldness in only one spot. It may occur anywhere on the head.
* '''Alopecia areata multilocularis''' refers to multiple areas of hair loss.
* The disease may be limited only to the beard, in which case it is called '''Alopecia areata barbae'''.<ref name=draelos/>
* If the patient loses all the hair on his/her scalp, the disease is then called '''[[Alopecia areata totalis]]'''.
* If all body hair, including [[pubic hair]], is lost, the diagnosis then becomes '''[[Alopecia areata universalis]]'''.<ref name=WebMD>[http://www.webmd.com/skin-problems-and-treatments/alopecia-areata Skin Conditions: Alopecia Areata]. WebMD. Retrieved on [[December 2]], [[2007]].</ref>
Alopecia areata totalis and universalis are rare.<ref name=WebMD/>
==Causes==
Alopecia areata is not [[Infectious disease|contagious]].<ref name=draelos/> It occurs more frequently in people who have affected family members, suggesting that [[heredity]] may be a factor.<ref name=draelos/> In addition, it is slightly more likely to occur in people who have relatives with [[autoimmune disease]]s.<ref name=WebMD/>
The condition is thought to be an [[autoimmune disorder]] in which the body attacks its own [[hair follicle]]s and suppresses or stops hair growth.<ref name=draelos/> There is evidence that [[T cell]] [[lymphocytes]] cluster around these follicles, causing inflammation and subsequent hair loss. An unknown environmental trigger such as [[emotional stress]] or a [[pathogen]] is thought to combine with hereditary factors to cause the condition.<ref name=merck/> There are a few recorded cases of babies being born with [[congenital]] alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system. Alopecia can be an adverse effect from using Prilosec, which is a Proton Pump Inhibitor that is used in treating GERD, among other things.{{Fact|date=May 2008}}
As with most autoimmune diseases, alopecia areata is associated with increased risk of developing other autoimmune diseases, specifically [[systemic lupus erythematosus]] or SLE.
May also be caused by Vitamin B5(pantothenate) deficiency. Needed as cofactor for acyl transfers, and for fatty acid synthase
==Diagnosis==
[[Image:Allopecia areata.JPG|thumb|Alopecia areata]]
First symptoms are small, soft, bald patches which can take just about any shape but are most usually round. It most often affects the scalp and beard but may occur on any hair-bearing part of the body.<ref name=merck/> There may be different skin areas with hair loss and regrowth in the same body at the same time. It may also go into remission for a time, or permanently.
The area of hair loss may tingle or be very slightly painful.<ref name=aocd>American Osteopathic College of Dermatology. [http://www.aocd.org/skin/dermatologic_diseases/alopecia_areata.html Alopecia Areata.] Dermatologic Disease Database. Aocd.org. Retrieved on [[December 3]], [[2007]].</ref>
The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.<ref name=draelos/>
Another presentation of the condition are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance.<ref name=draelos/>
One diagnostic technique applied by medical professionals is to gently tug at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair. In healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp. In cases of alopecia, hair will tend to pull out easier along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy. Professionals usually remind patients that the hair that is pulled out would eventually fall naturally. The test is conducted only once to identify the condition and rule out a simple localized hair loss condition.
Nails may have pitting or [[trachyonychia]].<ref name=merck/>
==Treatment==
Since the exact mechanisms are not ultimately understood, there is no known cure to date.
About 50% of patients' hair will regrow in one year without any treatment.<ref name=draelos/> If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. In 90% of cases, the hair will, ultimately, grow back. In the other 10%, only some or no hair will regrow.
In cases where there is severe hair loss, there has been limited success treating alopecia areata with [[clobetasol]] or [[fluocinonide]], steroid injections, or cream. Steroid injections are commonly used in sites where there are small areas of hair loss on the head or especially where eyebrow hair has been lost. Some other medications used are [[minoxidil]], irritants (anthralin or topical coal tar), and topical immunotherapy [[cyclosporine]], each of which are sometimes used in different combinations. Visual comparisons of alopecia areata sufferers who have been treated with Minoxidil in various concentrations can be viewed at the following link - http://www.belgraviacentre.com/thumbs_index1.php?gender=all&condition=Alopecia+Areata&Submit=Show.
Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs have [[Adverse effect (medicine)|adverse side effects]].<ref name=merck/>
Initial stages may be kept from increasing by applying topical [[corticosteroids]]. However, topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.<ref name=merck/>
Hair implants may help covering bald spots, but cannot guarantee satisfactory outcome, since the bald areas might expand.
Wigs can be prescribed if patients, especially female patients, mention social discomfort.
==Prognosis==
In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year.<ref name=aocd/> In cases with a greater number of patches, hair can either grow back or progress to alopecia totalis or, in rare cases, universalis.<ref name=aocd/>
Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of [[asthma]], [[allergy|allergies]], [[atopic]] dermal ailments, and even [[hypothyroidism]]. Loss of hair also means that the scalp [[sunburn|burns]] more easily in the sun. Loss of nasal hair increases severity of [[hay fever]] and similar allergic conditions. Patients may also have aberrant nail formation because [[keratin]] forms both hair and nails.
Episodes of alopecia areata before puberty predispose chronic recurrence of the condition.<ref name=merck/> Pitting of the fingernails can hint at a more severe or prolonged course.
Hair may grow back and then fall out again later.<ref name=WebMD/>
===Psychosocial issues===
Alopecia can certainly be the cause of psychological [[Stress (medicine)|stress]]. Because hair loss can lead to significant appearance changes, individuals may experience [[social phobia]], [[anxiety]], and [[depression (mood)|depression]]. In severe cases where the chance of hair regrowth is slim, individuals need to adapt to the condition, rather than look for a cure. There is currently little provision for psychological treatment for people afflicted with alopecia.
==See also==
* [[Alopecia totalis]]
* [[Alopecia universalis]]
* [[Baldness]]
* [[Locks of Love]]
==References==
{{reflist|2}}
== External links==
<!-- BEFORE inserting new links here you should first post it to the talk page, otherwise your edit is likely to be reverted-->
* {{DMOZ|Health/Conditions_and_Diseases/Skin_Disorders/Hair_Loss/Alopecia_Areata/}}
* [http://www.niams.nih.gov/hi/topics/alopecia/alopecia.htm National Institute of Arthritis and Musculoskeletal and Skin Diseases] at [[NIH]]
* {{DermAtlas|42}}
* [http://www.visualdxhealth.com/adult/alopeciaAreata.htm Medical Images of Alopecia Areata]
{{Diseases of the skin and subcutaneous tissue}}
[[Category:Autoimmune diseases]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]
[[de:Haarausfall]]
[[it:Alopecia areata]]
[[lt:Židininis nuplikimas]]
[[nl:Alopecia areata]]
[[ja:円形脱毛症]]
[[no:Alopecia areata]]
[[pl:Łysienie plackowate]]
[[pt:Alopécia]]
[[sv:Alopecia areata]]
[[tr:Alopesi areata]]
[[zh:圓禿]]