A characteristic feature is the presence of smooth, slightly erythematous or normal-colored apoplecic patches in hair [8]. The presence of hair tapered near proximal end is pathognomic but this is not always seen. A positive result following a pull test shows active presence of the disease and thus more hair loss should be expected. Additionally, hair loss on other hair bearing areas equally favours the diagnosis. The most common presentation is the appearance of one or more round-oval denuded patches. No epidermal changes are associated with the hair loss.

Nail involvement is seen in 6.8 to 49.4% of patients and is most common in patients with severe forms of the condition. One of the most common findings is pitting.

• Falling

  Entire patches of hair fall out as a result of the autoimmune system attacking the body’s hair follicles. Alopecia areata affects all ages and both enders. [nailsmag.com]

  In some cases, it may fall out again. Treatment doesn’t prevent hair from falling out in the future. Some medicines can help regrow hair faster, or stop hair from falling out. These medicines include: Corticosteroid medicine. [oregon.providence.org]

  This causes hair to fall out in clumps, even in those who are otherwise healthy. [headandshoulders.com]

• Pain

  There is no redness and often no pain, although a few people do find their skin itchy or painful to touch in the very early stages of AA development. Usually, though, there is no sensation -- just a patchy shedding of hair. [americanhairloss.org]

  Alopecia areata does not make you feel pain and does not make you sick. In most cases, hair falls out in small, round patches about the size of a quarter. This causes only a few bare patches. Some people may lose more hair. [niams.nih.gov]

  Alopecia areata is not life-threatening and does not cause physical pain. However, the cosmetic effects of hair loss can be devastating. [uptodate.com]

• Fever

  A 10-year-old boy presented with fever, stiff neck, and rash over the legs. During the course of his hospital stay, the clinical picture gradually evolved, and he met the criteria for Kawasaki disease (KD) on the seventh day of hospitalization. [ncbi.nlm.nih.gov]

  It generally happens in families whose members once or are suffering from atopic eczema, asthma, hay fever, early-onset diabetes, Addison’s disease, or pernicious anemia. Is AA treatable? Yes, it is treatable. [drpaulsonline.com]

  For hair loss due to illness (such as fever), radiation therapy, medicine use, or other causes, no treatment is needed. Hair usually grows back when the illness ends or the therapy is finished. [pennmedicine.org]

  These conditions include asthma, hay fever, eczema, psoriasis, vitiligo, rheumatoid arthritis, lupus, and thyroid disease. [onlinedoctor.superdrug.com]

• Anemia

  % Thyroid diseases 13 18.3 4 5.6 3.2 0.01 Hypothyroidism 10 14.1 2 2.8 5 0.01 Hyperthyroidism 2 2.8 2 2.8 1 0.61 Papillary carcinoma thyroid 1 1.4 - - - - Anemias 8 11.3 3 4.2 2.6 0.12 Iron deficiency anemia 6 8.4 2 2.8 3 0.27 Pernicious anemia 2 2.8 [ncbi.nlm.nih.gov]

  Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. [avensonline.org]

  It generally happens in families whose members once or are suffering from atopic eczema, asthma, hay fever, early-onset diabetes, Addison’s disease, or pernicious anemia. Is AA treatable? Yes, it is treatable. [drpaulsonline.com]

• Weakness

  This involves making the patient allergic to a substance (usually a chemical called diphencyprone) and then applying very weak strengths of this chemical to the bald patches, usually once a week to maintain a mild inflammation. [britishskinfoundation.org.uk]

  The hair around the affected patches is weak; and if you try to pull the hair around the patch, it is very easy to pull them out as compared to the other healthy parts of your head. [curriedayspa.com]

  In people with alopecia areata, many white blood cells gather around the affected hair root which is mistaken as foreign, subsequently causing inflammation which then leads to hairs becoming weak and falling out, causing bald patches. [independent.ie]

• Arthritis

  Some JAK inhibitors are already available on prescription in Australia, Europe and the USA to treat other diseases such as rheumatoid arthritis and myelofibrosis (a blood disorder). [theconversation.com]

  Because it is an autoimmune condition, other autoimmune issues may be present in a person suffering from alopecia areata, such as asthma, allergies, rheumatoid arthritis, or lupus. [nailsmag.com]

  The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. [web.archive.org]

  Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. [avensonline.org]

  The most common autoimmune comorbidities were vitiligo, psoriasis, thyroid disease, and juvenile idiopathic arthritis. © 2017 Wiley Periodicals, Inc. [ncbi.nlm.nih.gov]

• Loss of Eyebrow Hair

  If you have an obvious loss of eyebrow hair, you may choose to have injections of tiny dots of colored pigments into the eyebrow area (a procedure called dermatography). [drugs.com]

  It may, in some cases, be accompanied by loss of eyebrow hair or eyelashes, or beard hair in men.. Occasionally, a more diffuse pattern of Hair loss may be present. Pitting and ridging of the fingernails can occur. [ozarkderm.com]

• Alopecia

  Definition Alopecia areata (AA) is an autoimmune disease that affects almost 2% of the population in the US. [1] Safavi KH, Muller SA, Suman VJ, et al. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. [bestpractice.bmj.com]

  Picture of Alopecia Areata (Nails) Alopecia areata can affect the nails causing pitting, splitting, and other changes. The surface of the nail may appear rough or have lines or white spots. [emedicinehealth.com]

  Alopecia totalis Alopecia totalis results in hair loss across the entire scalp. Alopecia universalis Alopecia universalis is more advanced than alopecia totalis. [naaf.org]

  Those who have lost over 50% of their hair or have alopecia totalis or alopecia universalis are not as likely to see full regrowth. [onlinedoctor.superdrug.com]

• Eczema

  Types & treatments Childhood eczema Adult eczema Insider secrets Types of hair loss Treatment for hair loss Causes of hair loss Hair care matters Insider secrets What is psoriasis Diagnosis & treatment Skin, hair & nail care Triggers Insider secrets What [aad.org]

  People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma. [avensonline.org]

  Persons with AA may have a higher risk of atopic eczema, asthma, and nasal allergies, as well as other autoimmune diseases such as thyroid disease (Hashimoto’s thyroiditis), and vitiligo. [mariettaderm.com]

  It generally happens in families whose members once or are suffering from atopic eczema, asthma, hay fever, early-onset diabetes, Addison’s disease, or pernicious anemia. Is AA treatable? Yes, it is treatable. [drpaulsonline.com]

• Normal Hair

  “In all forms of alopecia areata, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. [nailsmag.com]

  In alopecia areata, for unknown reasons, the body's own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune cells inside of the hair follicles where they are not normally present. [web.archive.org]

  Given the role of these micronutrients in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation [ncbi.nlm.nih.gov]

  Alopecia areata often happens once and then there is regrowth of normal hair. Sometimes, recurrent episodes of hair loss may occur with periods of regrowth. This may occur over many years. [cincinnatichildrens.org]

• Pruritus

  Dermatological irAEs include maculopapular rash, pruritus, vitiligo, blistering disorders, mucocutaneous lichenoid eruptions, rosacea and the exacerbation of psoriasis. [ncbi.nlm.nih.gov]

  Signs & Symptoms Alopecia Areata most often is asymptomatic, but some patients (14%) experience a burning sensation or pruritus (itching) in the affected area(s). No correlation exists between the number of patches at onset and subsequent severity. [contourderm.com]

  Patient`s self-assessments of subjective symptoms (pruritus and pain) were also scored. Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. [kiss.kstudy.com]

  It typically starts on the central scalp and may be associated with pruritus, burning and pain. There may be peri follicular hyperkeratosis and erythema present. [omicsonline.org]

  Adverse effects include pruritus, erythema, scaling, staining of treated skin and fabrics, folliculitis, and regional lymphadenopathy 26-27. [bjmp.org]

• Leukonychia

  Red spotted lunulae, onycholysis, and punctate leukonychia were other reported findings. Other etiologies, such as onychomycosis or lichen planus, may coexist with or confound the diagnosis. [ncbi.nlm.nih.gov]

  Red spotted lunulae, onycholysis, and punctate leukonychia were other reported findings. Other etiologies, such as onychomycosis or lichen planus, may co-exist with or confound the diagnosis. Citation: Chelidze K, Lipner SR. [mdedge.com]

  Nail examination revealed severe onychodystrophy of all 20 nails, including onycholysis, onychorrhexis and leukonychia (fig. 1 b). Skin biopsy taken from the parietotemporal scalp was consistent with AA. [karger.com]

• Suggestibility

  As the name suggests HSPs are produced when cells are given heat shock. [belgraviacentre.com]

  Loss of microphthalmia-associated transcription factor-positive root sheath cells was seen, suggestive of loss of melanocyte stem cells. [ncbi.nlm.nih.gov]

  Sometimes, alopecia areata occurs within family members, suggesting a role of genes and heredity. Next: What are the different patterns of alopecia areata? >> Last Editorial Review: 8/30/2007 [web.archive.org]

• Anxiety Disorder

  Studies show that among patients with alopecia areata, 38–39 percent of them develop signs of depression and 39–62 percent of them develop generalized anxiety disorder. [draxe.com]

  AA is associated with a significant prevalence of psychiatric disorders including major depressive disorder, generalized anxiety disorder and social phobia. [1] Poor health-related quality of life (HRQoL) has been found in patients with AA, and greater [ijpd.in]

  […] has been reported in AA patients, with a 38%–39% lifetime prevalence of depression and a 39%–62% prevalence of generalized anxiety disorder.39–42 Adjustment disorders are also commonly found with AA.40 Table 3 outlines the rates of psychiatric disorders [dovepress.com]

• Confusion

  Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. [ncbi.nlm.nih.gov]

  Effectively, in the bodies of those suffering from alopecia areata, the immune system becomes confused. It begins to attack healthy hair follicles (which contain the roots of your hair). [headandshoulders.com]

  Habitual hair pulling ( trichotillomania ), scalp fungus (black-dot ringworm) and other skin diseases ( lichen planopilaris, cutaneous lupus and telogen effluvium ) cause the most confusion. [web.archive.org]

• Tingling

  Occasionally, there is mild itching, tingling, tenderness or a burning sensation in the affected area. [drugs.com]

  The hair loss that occurs in alopecia areata may appear suddenly with no symptoms or there may be mild itching or tingling. [nahrs.org.tempdomain.com]

  Some people feel a tingling sensation or very mild pain in the affected area. The scalp is the most commonly noticed area, but AA can form anywhere on the body: eyelashes, armpits, leg hairs, etc. [web.archive.org]

• Seizure

  Three of the 4 patients presented or developed other systemic disorders, including seizures, thrombocytopenia, optic neuritis, ulcerative colitis, allergic rhinitis, lymphadenopathy, vasculitic rash and positive p-ANCA values. [ncbi.nlm.nih.gov]

  Some medications that commonly cause telogen effluvium are anti-seizure medications, beta-blockers for high blood pressure, and anti-thyroid medications. In this situation, these medications should only be stopped after discussion with your doctor. [americanskin.org]

  Hannah has seizures which are also triggered by stress and finds her alopecia tends to be more severe when she has more fits. Some people thought medications they took for other conditions might have been triggers for their alopecia. [healthtalk.org]

• Paresthesia

  A prodrome of mild paresthesias, pruritus, tenderness or a burning sensation may precede hair loss but often times the hair loss is asymptomatic. Ninety-five percent of cases involve the scalp, but any hair-bearing area can be affected. [clinicaladvisor.com]

Clinical features are the basis of alopecia areata diagnosis [9].

Trichoscopy can also help in differential diagnosis. During diagnosis, trichoscopy shows regularly distributed yellow dots known as hyperkeratotic plugs, small exclamation-mark hairs and black dots.

A biopsy is rarely needed. Histologic findings include peribulbar lymphocytic infiltrate. In some cases of inactive alopecia areata, inflammatory states may not be found. Other helpful findings include pigment incontinence in the hair bulb, follicular stelae as well as a shift in the anagen-to-telogen ratio towards higher telogen.

Since the condition is benign, treatment is not mandatory [10]. This is also bearing in mind spontaneous remissions and recurrences. Treatments used are believed to stimulate hair growth but there is yet no clear evidence as to whether they affect the natural course of alopecia areata or not. Treatment modalities are often decided on based on the extent of hair loss as well as the age of the patient.

Topical treatments deployed include the use of corticosteroids, topical immunotherapy, anthralin and minoxidil. Systemic treatments include the use of psoralen plus, prednisone, cyclosporine, tacrolimus, interferon, dapsone and methotrexate.

In many cases which start as a small number of patches of hair loss, the hair grows back after a few months to a year [7]. In cases where there is a greater number of patches, hair can either grow back or progress to more severe forms of the condition (Alopecia totalis or universalis).

The effect of this condition is mostly psychological, being loss of self-image as a result of hair loss. Loss of hair equally means more scalp sun burns following easy exposure to the sun. Loss of nasal hair increases severity of hay fever or other such similar allergic conditions. Since keratin forms both hair and nails, patients may witness aberrant nail formation.

Hair may grow back and fall out again later. This doesn’t indicate a recurrence of the condition. Rather it may be a natural cycle of growth and shedding. Onset of this condition before puberty predisposes the individual to chronic recurrences of the condition.

Alopecia areata is not contagious [2]. It occurs more frequently in people who have family members affected by the condition which suggests a strong genetic predilection. Strong evidence of genetic association with increased risk for the condition was demonstrated by the identification of at least four susceptibility loci on chromosomes 6, 10, 16 and 18. It is also most likely to occur in people who have relatives with autoimmune conditions.

Alopecia areata is believed to be a systemic autoimmune disorder where the body attacks its own anagen hair follicles, suppressing or stopping hair growth [3].

On estimate, the global prevalence of alopecia areata is approximately 1 on 1000 people, with the lifetime risk put at approximately 2% [4]. For many patients, the onset of the condition is before age 30. However, men and women are affected equally.

The pathophysiology for this condition is still open to debate. However, one hypothesis is commonly acccepted in different circles and this is the fact that alopecia areata is a T-cell mediated autoimmune condition with a higher possibility of occurrence in individuals that are genetically compromised for the condition [5]. Over the course of history, there is a lot of evidence to support this hypothesis. 

Although the process appears to be T-cell mediated, antibodies channeled to hair follicle have been seen more in patients with this condition when compared to the control subjects [6]. With the aid of immunofluorescence, antibodies to anagen-phase hair follicles were seen in as much as 90% of patients with alopecia areata. This is in comparison to less than 37% of control subjects.

The autoantibody response is heterogenous and targets multiple structures of the anagen-phase hair follicle. The outer root sheath is the structure that is targeted most frequently and this is followed by the inner root sheath, the matrix and finally the hair shaft in that order. Whether these antibodies play a direct role in the pathophysiology is not yet known.

Since external etiologic factors are poorly documented and a genetic pathway has been established for the development of the disease, there is no clear way of preventing this disease.

Alopecia areata is a recurrent, nonscarring hair loss condition, affecting parts of the body with hair growing abilities [1]. Clinically, alopecia areata can occur in a variety of patterns. It is of a benign nature but this doesn’t stop it from bringing about a great deal of emotional and psychosocial distress in people affected and those around them. 

Alopecia areata is a condition that brings about hair loss on not just your scalp but the entire body. It can be as a result of heredity, certain medications consumed or other medical conditions. It is mostly seen in people in their 30s but can happen in people of all age groups.

The loss of hair takes different shapes and happens in any part of the body.

Treatment is not compulsory unless when the individual finds the condition to be worrying (more serious cases), in that case, medications or surgery can be used to bring back hair growth in the region affected.