II. Definition

  1. Non-scarring autoimmune Alopecia

III. Epidemiology

  1. No gender predominance
  2. Most common under age 30
  3. Prevalence: 0.1 - 0.2% of U.S. population

IV. Types

  1. Alopecia Areata: Patches of Hair Loss
  2. Alopecia Totalis: Hair Loss over entire scalp
  3. Alopecia Universalis: Hair Loss over entire body

V. Signs

  1. Well-demarcated oval patches of Hair Loss
  2. Exclamation Point Hairs at edges of Hair Loss (2-3 mm broken hairs)
    1. Club shaped Hair Root
    2. Thin proximal Hair Shaft
    3. Normal caliber distal Hair Shaft

VII. Differential Diagnosis

  1. Other non-scarring Alopecia
  2. Tinea Capitis

IX. Management: Moderate Involvement (<50% of scalp involved)

  1. Intralesional Kenalog
    1. Treatment of choice
    2. Dilute Kenalog 40 mg/ml with saline to 10 mg/ml
      1. Kenalog 40 mg/ml: 0.5 ml
      2. Saline: 2 ml
    3. Inject 0.1 ml into patch at 1 cm intervals
    4. Inject into mid-Dermis via 0.5 inch needle
    5. Adverse effects: Atrophy
      1. Avoid injecting too superficially
      2. Avoid injecting >0.1 ml or >10 mg/ml per site
      3. Limit injections to no more often than q4-6 weeks
      4. Discontinue if no improvement at 6 months
  2. Adjuncts to intralesional injection
    1. Apply Minoxidil 5% solution twice daily or
    2. Mid-potency Topical Corticosteroid (eg. Kenalog 0.1%)
      1. Apply 1 ml to entire scalp twice daily

X. Management: Severe Involvement (>50% of scalp involved)

  1. General: Combination therapy often used
    1. Contact sensitizers with intralesional Kenalog
      1. Most effective option
      2. Usually requires referral to dermatology
    2. Minoxidil 5% bid with Topical Steroids or Anthralin
  2. Topical Anthralin Cream (Psoriatec) 0.5 to 1% cream
    1. Course usually limited to 6 months
    2. Apply daily and leave on for 5 minutes to start
      1. Gradually increase time applied up to 60 minutes
    3. Rinse scalp well and then clean with soap
    4. New Hair Growth seen within 3 months
  3. Mid-potency Topical Corticosteroid (eg. Kenalog 0.1%)
    1. Apply 1 ml to entire scalp twice daily
  4. Topical Minoxidil 5%
    1. Use as adjunct to Anthralin or Corticosteroid
  5. Prednisone (less commonly used)
    1. Start: 40 mg PO qd for 7 days
    2. Taper: Decrease by 5 mg q3 days
    3. Course completed within 6 weeks
  6. Dermatology Consultation for contact sensitizer
    1. Dinitrochlorobenzene
    2. Diphenylcyclopropenone
    3. Squaric acid dibutyl ester

XI. Course

  1. Spontaneously resolves in 6-12 months in most cases
    1. Hair pigmentation may be different in regrowth area
    2. Some cases progress (see prognostic indicators below)
  2. Recurs in 30% of cases (often affects same area)

XII. Prognosis: Indicators of poor prognosis

  1. Course duration longer than one year
  2. Onset of Alopecia prior to Puberty
  3. Family History of Alopecia Areata
  4. Atopic Patients
  5. Down Syndrome

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Ontology: Alopecia Areata (C0002171)

Definition (MSH) Loss of scalp and body hair involving microscopically inflammatory patchy areas.
Concepts Disease or Syndrome (T047)
MSH D000506
ICD9 704.01
ICD10 L63 , L63.9
SnomedCT 201131001, 238727007, 68225006
English ALOPECIA AREATA, Alopecia areata, unspecified, alopecia areata (diagnosis), alopecia areata, Alopecia Areata [Disease/Finding], Alopecia Areata, areata alopecia, patchy hair loss, Alopecia Circumscripta, Circumscribed alopecia (disorder), Patchy hair loss, Multifocal alopecia, Alopecia circumscripta, Alopecia areata, Patchy loss of hair, AA - Alopecia areata, Circumscribed alopecia, Alopecia areata (disorder), circumscripta; alopecia, pelade, alopecia; areata, alopecia; circumscripta, areata; alopecia
Spanish ALOPECIA AREATA, alopecia areata, alopecia circunscripta (trastorno), alopecia circunscripta, pérdida de pelo en placas, Alopecia areata, Alopecia Areata
German ALOPECIA AREATA, Alopecia areata, nicht naeher bezeichnet, Alopecia areata
Swedish Alopecia areata
Japanese エンケイダツモウショウ, 円形脱毛, 脱毛症-円形, 円形脱毛症
Czech alopecia areata, Ohraničené vypadávání vlasů
Finnish Pälvikaljuisuus
Russian PLESHIVOST' GNEZDNAIA, ALOPETSIIA GNEZDNAIA, ALOPETSIIA OCHAGOVAIA, АЛОПЕЦИЯ ГНЕЗДНАЯ, АЛОПЕЦИЯ ОЧАГОВАЯ, ПЛЕШИВОСТЬ ГНЕЗДНАЯ
Portuguese ALOPECIA AREATA, Alopécia areata, Alopecia em Áreas
French ALOPECIE EN AIRE, Alopecia areata, Pelade
Korean 원형 탈모증, 상세불명의 원형 탈모증
Croatian ALOPECIA AREATA
Polish Łysienie plackowate
Hungarian Alopecia areata
Norwegian Alopecia areata, Flekkvist håravfall
Dutch alopecia; areata, alopecia; circumscripta, areata; alopecia, circumscripta; alopecia, Alopecia areata, niet gespecificeerd, alopecia areata, Alopecia areata
Italian Alopecia areata

Ontology: Exclamation point hair (C0263495)

Concepts Disease or Syndrome (T047)
SnomedCT 4403007
English Exclamation point hair, Exclamation point hair (disorder)
Spanish pelo en signo de admiración (trastorno), pelo en signo de admiración

Ontology: Alopecia totalis (C0263504)

Concepts Disease or Syndrome (T047)
ICD10 L63.0
SnomedCT 19754005
French PELADE, Pelade décalvante
English Alopecia (capitis) totalis, ALOPECIA TOTALIS, alopecia totalis (diagnosis), alopecia totalis, total alopecia (physical finding), total alopecia, total baldness was noted, alopecia capitis totalis, Alopecia totalis, Total alopecia areata, Alopecia totalis (disorder), alopecia; totalis, totalis; alopecia
Italian Alopecia totale
Japanese 全頭脱毛症, ゼントウダツモウショウ
Portuguese ALOPECIA TOTAL, Alopécia total
German Alopecia (cranialis) totalis, Alopecia totalis
Czech Totální alopecie
Korean 전두(머리의)탈모증
Hungarian Alopecia totalis
Dutch alopecia; totalis, totalis; alopecia, Alopecia (capitis) totalis, alopecia totalis
Spanish alopecia total (trastorno), alopecia total, Alopecia total

Ontology: Alopecia universalis (C0263505)

Concepts Disease or Syndrome (T047)
MSH C537055
ICD10 L63.1
SnomedCT 201145007, 86166000
Italian Alopecia universale
Japanese 汎発性脱毛症, ハンパツセイダツモウショウ
English ALOPECIA UNIVERSALIS, AU, Alopecia universalis, Generalized Atrichia, alopecia universalis, Atrichia, Generalized, alopecia universalis (diagnosis), Universal alopecia areata, Alopecia universalis (disorder), alopecia; universalis, universalis; alopecia
Czech Alopecia universalis
Korean 범발성 탈모증
Hungarian Alopecia universalis
Dutch alopecia; universalis, universalis; alopecia, Alopecia universalis, alopecia universalis
Spanish alopecia universal (trastorno), alopecia universal, Alopecia universal
Portuguese Alopécia universal
French Pelade universelle
German Alopecia universalis