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$Unique_ID{BRK03442}
$Pretitle{}
$Title{Alopecia Areata}
$Subject{Alopecia Areata Alopecia Celsi Alopecia Circumscripta Jonston's
Alopecia Porrigo Decalvans Vitiligo Capitis Cazenave's Vitiligo Celsus'
Vitiligo Alopecia Universalis (Alopecia Totalis) Alopecia Semiuniversalis
Trichotillomania Hypotrichiasis (Alopecia Congenitalis, Alopecia Adnata,
Congenital Baldness, Congenital Alopecia) Alopecia Medicamentosa Alopecia
Mucinosa Alopecia Neurotica Postpartum Alopecia Premature Alopecia Alopecia
Presenilis Alopecia Symptomatica Syphilitic Alopecia Alopecia Toxica (Toxic
Alopecia) Alopecia Triangularis Congenitalis}
$Volume{}
$Log{}
Copyright (C) 1987, 1988, 1989 National Organization for Rare Disorders,
Inc.
443:
Alopecia Areata
** IMPORTANT **
It is possible the main title of the article (Alopecia Areata) is not the
name you expected. Please check the SYNONYMS listing on the next page to
find alternate names, disorder subdivisions, and related disorders covered by
this article.
Synonyms
Alopecia Celsi
Alopecia Circumscripta
Jonston's Alopecia
Porrigo Decalvans
Vitiligo Capitis
Cazenave's Vitiligo
Celsus' Vitiligo
DISORDER SUBDIVISIONS
Alopecia Universalis (Alopecia Totalis)
Alopecia Semiuniversalis
Information on the following diseases can be found in the Related
Disorders section of this report:
Trichotillomania
Hypotrichiasis (Alopecia Congenitalis, Alopecia Adnata, Congenital
Baldness, Congenital Alopecia)
Alopecia Medicamentosa
Alopecia Mucinosa
Alopecia Neurotica
Postpartum Alopecia
Premature Alopecia
Alopecia Presenilis
Alopecia Symptomatica
Syphilitic Alopecia
Alopecia Toxica (Toxic Alopecia)
Alopecia Triangularis Congenitalis
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources
section of this report.
Alopecia Areata is a progressive condition characterized by loss of hair.
The cause is unknown, and unpredictable hair loss is the only noticeable
symptom. Regrowth of hair may or may not occur. Some cases may be
associated with endocrine abnormalities, infection of the scalp, or an
autoimmune reaction. Hair loss is usually confined to the head and face,
although the entire body may be involved.
Symptoms
Alopecia Areata often begins suddenly with oval or round bald patches
appearing most commonly on the scalp. Other areas of hairy skin may also be
involved. Gradually, the affected skin becomes white and smooth. New
patches may spread by joining existing bald patches. These larger bald areas
can appear while hair is regrowing in older hairless patches. Loss of hair
can be permanent in some cases. Hair follicles may deteriorate, but oil
producing glands in the skin (sebaceous glands) usually change very little.
The skin does not become hard or atrophied. In a very few cases, all body
hair may be lost. Cases beginning during childhood tend to be more severe
than cases with an onset during adulthood.
Causes
The exact cause of Alopecia Areata is not known. An autoimmune mechanism is
suspected in this disorder. Autoimmune disorders are caused when the body's
natural defenses (antibodies) against invading organisms suddenly begin to
attack healthy tissue. Some cases may be linked to abnormal reactions by
blood cells (serum antibodies) to a thyroid protein (thyroglobulin), stomach
(parietal) cells, or adrenal cells.
Affected Population
Alopecia Areata affects males and females in equal numbers. Cases may begin
during childhood or adulthood. According to a 1983 study at the Mayo Clinic
in Rochester, MN, approximately 2 million cases of this disorder were
estimated in the United States at that time.
Related Disorders
Loss of hair (alopecia) can occur from a wide variety of causes. Symptoms of
the following disorders can be similar to those of Alopecia Areata.
Comparisons may be useful for a differential diagnosis:
Trichotillomania, also known as hair pulling, is a neurotic habit that
usually appears in children. It may remain undiagnosed for a long time. The
hairs may be broken off or pulled out. Stubby regrowth may replace damaged
hair or bald areas. This mental illness may be hard to distinguish from
Alopecia Areata without careful observation of the affected child's habits.
Hair can be similarly damaged by permanent wave solutions, softeners or hot
combs. (For more information on this disorder, choose "trichotillomania" as
your search term in the Rare Disease Database.)
Hypotrichiasis (Hypotrichosis, Alopecia Congenitalis, Alopecia Adnata,
Congenital Alopecia, Congenital Baldness) is a condition characterized by the
absence of hair at birth. This disorder is usually inherited as a dominant
trait, but can also be due to a recessive gene. It often occurs in
association with other surface skin layer (ectodermal) defects.
Alopecia Medicamentosa is characterized by widespread hair loss, most
commonly of the scalp, caused by a reaction to various types of drugs in
sensitive or allergic individuals. It may also be a result of chemotherapy
used in treating various disorders (e.g., cancer).
Alopecia Mucinosa, also known as Follicular Mucinosis, occurs in children
and young adults. Hard, reddish, well defined plaques underlie the areas of
hair loss. A fine scaling may develop on the face, scalp, trunk, arms or
legs. A loss of sensation may occur as the plaques develop. The exact cause
of this form of hair loss in not known, although a skin inflammation is
suspected. Symptoms often spontaneously resolve after a few months in many
cases.
Alopecia Neurotica is characterized by hair loss caused by injury to the
nerves in the area where balding occurs.
Postpartum Alopecia is characterized by temporary loss of hair at the
termination of a pregnancy. The cause is not known.
Premature Alopecia is characterized by male pattern baldness occurring at
an abnormally early age.
Alopecia Presenilis is characterized by ordinary or common baldness
occurring in early or middle life without any apparent disease of the scalp.
This condition is very common in males, but rare in females.
Alopecia Symptomatica is characterized by hair loss associated with other
illnesses or conditions, most commonly following prolonged illnesses marked
by high fever.
Alopecia Toxica, also known as Toxic Alopecia, is characterized by hair
loss thought to be caused only by fever.
Alopecia Triangularis Congenitalis is a congenital defect consisting of a
triangular patch of baldness on the front of the scalp.
Therapies: Standard
Treatment of Alopecia Areata is directed at producing regrowth of hair.
Drugs such as systemic corticosteroids may cause the hair to grow, but long-
term treatment may have undesirable side effects. Triamcinolone acetonide
suspension may be beneficial but the effect is often temporary.
For cosmetic reasons, wigs and hairpieces may be necessary, especially
for affected women and children.
Therapies: Investigational
Treatment of Alopecia Areata involving a combination of 8-methoxypsoralen
ointment and ultraviolet light exposure is being attempted experimentally,
and may not be successful in all cases. More research is necessary to
determine other treatment combinations to prolong beneficial effects in
patients. Some researchers believe ultraviolet light may trigger a change in
the immune system (immunomodulation) which might control hair loss in
Alopecia Areata. Synthetic immunomodulator drugs such as Isoprinosine and
diphencyprone are also under investigation as possible treatments for this
disorder. A clinical trial involving low doses of the drug spironolactone,
also used to treat excessive hair growth in females due to hormonal
imbalances, is under way. A trial of the drug minoxidil indicated no benefit
for severe Alopecia Areata patients. Other tests involve the drug
dinitrochlorobenzene (in ointment form) as compared with squaric acid
dibutylester. This is not recommended due to adverse side effects in some
test participants. More extensive research is necessary before the
therapeutic value of these drugs can be evaluated.
Cyclosporine (Sandimmune) may be of potential benefit for treating a
number of dermatologic diseases. These include Pemphigus and Bullous
Pemphigoid, Posterior Uveitis and Behcet's Syndrome, collagen vascular
disorders such as severe Dermatomyositis, Sjogren's Syndrome, and
Scleroderma, Mycosis Fungoides, and Alopecia Areata. However, this drug may
also be associated with severe and life-threatening side effects which would
limit its use in many patients.
Careful monitoring of this drug by a physician is necessary to guard
against possible toxic side effects. Relapses can occur when the drug is
discontinued. More research is needed before cyclosporine can be recommended
as a treatment for all but the most severe cases of the disorders listed
above. Even for the most severe cases its use is still experimental, and
long-term effects are unknown.
This disease entry is based upon medical information available through
November 1988. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Alopecia Areata, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
National Alopecia Areata Foundation
P.O. Box 15076
San Rafael, CA 94901-0760
(415) 456-4644
The National Arthritis and Musculoskeletal and
Skin Diseases Information Clearinghouse
Box AMS
Bethesda, MD 20892
(301) 495-4484
References
TOPICAL PHOTOCHEMOTHERAPY FOR ALOPECIA AREATA: A.J. Mitchell, et al.; J Am
Acad Dermatol (April 1985, issue 12(4) ). Pp. 644-649.
CLINICAL AND IMMUNOLOGIC RESPONSE TO ISOPRINOSINE IN ALOPECIA AREATA AND
ALOPECIA UNIVERSALIS: ASSOCIATION WITH AUTOANTIBODIES: M. Lowy, et al.; J
Am Acad Dermatol (January 1985, issue 12(1 Pt 1). Pp. 78-84.
LOW-DOSE SPIROMOLACTONE IN THE TREATMENT OF FEMALE HIRSUTISM: Int J
Fertil (Jan-Feb 1987, issue 32(1)). Pp. 41-45.