22-Year-Old Male with Several Discrete Patches of Hair Loss

Abstract

Alopecia areata (AA) is an immune mediated, non-cicatricial, hair loss. AA may occur at any age and has an estimated lifetime incidence of 1.7%. Hair loss may range from localized, discrete patches or comprise the total body surface. The etiology of AA is multifactorial and thought to be caused by autoimmune, environmental, and genetic factors. Upon histological analysis, hair follicles afflicted by AA may reveal dense inflammatory cell infiltrate surrounding the bulbar region of anagen hair follicles. Dermatoscopic evaluation may reveal short, broken hairs with narrow proximal ends and thicker distal portions referred to as “exclamation mark” hairs. AA may be diagnosed clinically by the presence of often sharply demarcated round or oval-shaped areas of sudden, patchy hair loss. The rate of remission of AA is thought to be dependent on the amount of scalp involvement upon initial diagnosis. The general treatment approach to AA should include education regarding prognosis to facilitate informed decisions regarding treatment preferences. Patients should be directed to resources including opportunities to participate in clinical trials, products available to conceal hair loss, and psychosocial support upon initial diagnosis. Intralesional corticosteroids are considered to be first-line therapy for individuals experiencing limited disease and as adjunctive therapy in patients experiencing extensive disease. In patients with limited disease, topical corticosteroids have also shown clinical benefit particularly due to local anti-inflammatory effects. Topically applied agents may be used alone or in combination with additional treatment modalities and may be preferred over injections in the pediatric population. Minoxidil, methotrexate, or topical immunotherapy may also be considered based upon patient specific factors. A wide range of new therapeutic modalities with promising initial results are currently under investigation for the treatment of AA including statins, phosphodiesterase-4 inhibitors, Janus kinase (JAK) inhibitors, and platelet rich plasma (PRP).KeywordsAlopecia areatanon-cicatricialautoimmuneexclamation mark hairscorticosteroids