- Alopecia Ophiasis: Loss of Hair Along the Margin - Dr.Hanish Babu, MD
Alopecia areata occurs most commonly between the ages of 15 and 35 years. One or more, round or oval smooth patches of hair loss appear on the scalp, eyebrows, beard or other hair bearing areas. The patches are of varying sizes and shapes. The hairs at the margin of the patches taper towards the surface, presenting the classical ‘exclamation mark’ hairs, typical of alopecia areata. These hairs are weak and can easily be pulled out.
Nails are affected in 10–20% of cases and show a regular array of horizontally or perpendicularly arranged pits on the nail plate. The lunula (the semicircular white mark near the cuticle of the nail) may show spotty loss of the white color in some patients. In very severe cases, the nails may become rough and get separated from the matrix.
An increased incidence of other autoimmune diseases, like Hashimoto’s thyroiditis and vitiligo, are seen among alopecia areata patients.
What are the Different Clinical Presentations of Alopecia Areata?
Alopecia areata usually presents as single or multiple areas of hair loss, most commonly on the scalp, and also on other hair bearing areas like the beard, eyebrows, eyelashes, pubic hair and other body areas.
- Alopecia totalis denotes total loss of scalp hair.
- In alopecia universalis, there is total loss of hair from the body, including the scalp.
- Ophiasis: band like hair loss from the scalp margins.
- Sisaphio or reverse ophiasis: hair loss limited to the top, center and vertex of the scalp, sparing the margins.
Is it Necessary to Treat All Cases of Alopecia Areata?
Spontaneous regrowth is quite common in alopecia areata. Hence, localized, small patches of hair loss need not be treated, except for cosmetic purposes. New hair growth, either spontaneous or following treatment. may be sparse and non-pigmented in many cases. There is no need to worry; full thickness, healthy hairs will grow out within a few months.
However, if there is extensive, continuous loss of patchy hair loss, a dermatological consultation is mandatory.
Many patients have associated caries teeth or other dental infections. A dental consultation is also advisable in recurrent cases of alopecia areata.
What is the Normal Course and Prognosis of Alopecia Areata?
The hair loss in alopecia areata is gradual over weeks to months, though in some individuals the patches may appear and spread within a span of few days. The bald patches may remain stable and show slow spontaneous hair growth over a period of several months.
Alopecia areata has an unpredictable course. Treated or untreated, recurrences are quite common in alopecia areata. New patches may appear elsewhere while hair growth occurs in the existing patches.
Eighty percent of those getting alopecia areata after puberty can expect regrowth of the hair with or without treatment. However, in extensive alopecia areata and the totalis and universalis varieties, only less than 10% get spontaneous regrowth. For this reason, these patients should receive aggressive therapeutic intervention.
Resistance to treatment and poor prognosis is evident in the following situations.
- Early age of onset: childhood alopecia areata is often difficult to treat.
- Extensive alopecia, total alopecia and alopecia universalis portend poor prognosis.
- Family history of alopecia and history of atopy or allergic tendencies in the individual or among close relatives.
- Nail involvement indicates higher levels of auto-antibodies and poor prognosis.
What are the Laboratory Investigations to be Carried Out in Cases of Alopecia Areata?
In localized patchy hair loss, the clinical appearance is sufficient to make a diagnosis. However, in recurrent cases or patients presenting with extensive alopecia areata, certain laboratory investigations are mandatory.
- Complete blood counts with erythrocyte sedimentation rate(ESR): to rule out any concurrent systemic infections or blood disorders.
- Thyroid function tests are necessary to rule out concomitant thyroid problems.
- T and B lymphocyte estimation to assess the levels of auto-antibodies against the hair follicles.
- Biopsy and histopathological examination of the alopecia patch is indicated for research purposes only. Bee swarm-like clusters of lymphocytes around the hair follicles is typical in alopecia areata. Otherwise, the epidermis and dermis are normal.
- In recurrent cases, an antinuclear antibody test to rule out systemic lupus erythematosus, an RPR test to rule out syphilis and a KOH preparation to rule out fungal infections are also mandatory to exclude other major patchy hair loss causes.
Alopecia areata, when extensive and recurrent, can cause intense anxiety and stress in affected individuals. It is necessary to provide emotional support to the patient both at home and in the dermatology consultation. Reassurance is necessary and the chances of spontaneous recovery should be stressed. It is also necessary to look out for all the implicated causes of patchy hair loss in alopecia areata. Once these are ruled out or tackled if present, in an initial attack of alopecia areata with small, limited number of patches, the patient should be offered the option of not taking any treatment at all. Wait and watch is the best policy in such cases.
Further Reading
- What are the Causes of Reversible Patchy Hair Loss?
- Causes of Irreversible, Scarring Type of Patchy Loss of Hair
- How to Get Rid of the Patchy Hair Loss in Alopecia Areata?
- Treatment of Alopecia areata: National Alopecia Areata Foundation
Source
- Ralf P, Elis AO, Andrew GM. Hair Growth Disorders, in Fitzpatrick’s Dermatology in General Medicine. 7th Ed, 1: 753-777, 2008
- Messenger AG. Alopecia areata, in Rook’s Text Book of Dermatology, 8th Ed, 4: 66.31-66.38, 2010
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
