Figure 1
Autoimmune T-cell mediated disease in genetically predisposed persons. Uncommon association with other autoimmune diseases—diabetes, vitiligo, thyroid disease
Physical: Well-circumscribed areas of complete hair loss on any hair bearing surface (scalp = 90%); may see nail pitting; "exclamation point" hairs at periphery of bald patch
- Totalis = entire scalp; universalis = all hair-bearing areas; ophiasis = hair loss confluent along temporal & occipital scalp
DDx: androgenetic alopecia, tinea capitis, trichotillomania, telogen effluvium
Investigations: ferritin, TSH, ANA, scalp biopsy if unsure
- High-potency topical steroids; intralesional triamcinolone acetonide (5-10 mg/cc) q 4-6 wk in adults has best outcome.
- Some benefit reported with topical anthralin, topical minoxidil.
- Less commonly: Topical immunotherapy (i.e., diphencyprone), oral steroids (use in early rapidly progressing widespread disease), cyclosporine.
- Course: 95% regrow in 1 yr (except totalis or universalis, which have poor prognosis); 30% recurrence.
- Poor prognostic signs: Atopic dermatitis, childhood onset, duration >5 yr, onychodystrophy, ophiasis, widespread involvement.