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Alopecia areata

Background

Overview

Definition
Alopecia areata is an autoimmune disease characterized by non-scarring hair loss, where the immune system attacks the hair follicles, leading to hair loss.
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Pathophysiology
The pathophysiology of alopecia areata involves the collapse of the immune privilege of the hair follicle and subsequent autoimmune attack. This is mediated by various immune cells and cytokines, including regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, IL-2/interleukin-21, and interferon-gamma.
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Epidemiology
The prevalence of alopecia areata worldwide is estimated at 212.77 per 100,000 population.
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Disease course
Clinically, alopecia areata presents as patchy, non-scarring hair loss, generally affecting the scalp, but can also affect other parts of the body. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. Nail changes, such as pitting and trachyonychia, can also be present in some patients.
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Prognosis and risk of recurrence
The prognosis of alopecia areata is unpredictable and varies widely among individuals. While spontaneous regrowth of hair is common, the disease can also progress to more extensive hair loss.
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Guidelines

Key sources

The following summarized guidelines for the management of alopecia areata are prepared by our editorial team based on guidelines from the British Photodermatology Group (BPG/BAD 2019), the British Association of Dermatologists (BAD 2012), and the American Academy of Family Physicians (AAFP 2009). ...
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Medical management

Topical therapy
As per BAD 2012 guidelines:
Offer potent topical corticosteroids in patients with limited alopecia areata.
B
Recognize that other topical treatment options include minoxidil
B
and dithranol.
B
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  • Contact immunotherapy

  • Systemic therapy

Nonpharmacologic interventions

Wig and hairpiece
As per BAD 2012 guidelines:
Offer wig/hairpiece use in patients with extensive alopecia areata.
B
Offer wig use in patients with alopecia totalis/universalis.
B

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  • Alternative and complementary therapies

Therapeutic procedures

Intralesional corticosteroids: as per BAD 2012 guidelines, consider performing intralesional corticosteroid injections in patients with limited alopecia areata.
C

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  • Phototherapy

  • Laser therapy

Specific circumstances

Eyelash alopecia: as per BAD 2012 guidelines, recognize that prostaglandin F2-alpha analogs (latanoprost and bimatoprost) have limited roles in the management of patients with eyelash alopecia.
B