Non-scarring alopecias
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Figure 3.51
A: Alopecia areata
B: Trichotillomania
(Courtesy of Dr. Paul Getz)
C: Telogen effluvium |
Alopecia Areata (Figure 3.51A)
- Most common non-scarring alopecia; unknown etiology but likely
T cell-mediated autoimmune condition in patients with genetic
predisposition
- Presents with round to oval alopecic non-scarring patches on scalp, ‘exclamation
mark’ hairs; different patterns include patchy (most common),
reticular, diffuse with generalized thinning, alopecia totalis (loss of entire
scalp hair), alopecia universalis (loss of scalp and body hair), ophiasis
pattern (band-like hair loss at periphery of temporal/occipital scalp)
- May have nail involvement (pitting most common)
- Histology: lymphocytes surrounding lower portion of hair follicle resembling
‘swarm of bees’, ↑ miniature telogen and catagen follicles
- Treatment: topical/intralesional corticosteroid, other topicals (squaric acid,
anthralin, minoxidil), excimer laser, systemic corticosteroid or
cyclosporine
- Associations: thyroid disease, vitiligo, atopy, IBD, IDDM,
polyendocrinopathy
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