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Alopecia areata - Hair and Scalp
See also in: Overview,External and Internal Eye,Nail and Distal Digit
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Alopecia areata - Hair and Scalp

See also in: Overview,External and Internal Eye,Nail and Distal Digit
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Contributors: Sarah N. Robinson MD, Belinda Tan MD, PhD, Mary Gail Mercurio MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Alopecia areata is a T-lymphocyte mediated autoimmune disease of the hair follicle resulting in nonscarring hair loss. Most cases are limited to 1 or 2 small patches of alopecia that involve the scalp, eyebrows, or body hair, but in severe cases, all of the hair on the scalp is lost (alopecia totalis) or all scalp and body hair is lost (alopecia universalis). History of sudden onset is characteristic. Alopecia areata is seen equally in both sexes and in patients of all ages and ethnicities, although it is most common in patients between the ages of 5 and 40. There is an increased incidence of alopecia areata in patients with Down syndrome as well as those with autoimmune diseases, most commonly thyroid disease. Patients with alopecia areata are also more likely to have atopy, and its presence is felt to be a poor prognostic indicator.

The course of alopecia areata is unpredictable, with wide variation in duration and extent of disease occurring from patient to patient. In most patients, hair will eventually spontaneously regrow, although recurrences are common. The condition is treatable but cannot be cured.

In one retrospective study of 321 patients, temporal area involvement was independently associated with worse prognosis (in addition to extent of hair loss).

Codes

ICD10CM:
L63.9 – Alopecia areata, unspecified

SNOMEDCT:
68225006 – Alopecia areata

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Trichotillomania, from the twisting and pulling of hair, may mimic alopecia areata. Hairs are broken off at varying lengths. 
  • Telogen effluvium from nutritional, hormonal, and drug etiologies can lead to large clumps of hair loss in a similar fashion to alopecia areata. The loss is diffuse, not localized.
  • Tinea capitis has hair loss accompanied by scale and inflammation.
  • Secondary syphilis can result in diffuse patchy alopecia.
  • Androgenetic alopecia – male or female pattern
Scarring alopecia:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 04/11/2017
Last Updated: 04/01/2019
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Alopecia areata - Hair and Scalp
See also in: Overview,External and Internal Eye,Nail and Distal Digit
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Alopecia areata : Sparse eyebrows, Eyelash loss, Round areas of alopecia
Clinical image of Alopecia areata
A smooth round patch of nonscarring alopecia on the occipital scalp with early hair regrowth after intralesional steroid injection.
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