Baldness in spots

Baldness in spots or Alopecia areata (AA) is an autoimmune disease which appears in the form of round and clearly defined areas where hair is completely missing.

baldness in spots

Alopecia areata usually occurs in children, and in 60% of the patients it appears before the age of 20. The cause of the disease is not entirely explained. It is considered that it appears due to several different factors. Emotional stress and genetical predisposition significantly influence the development of AA, but the primary cause is the disorder in the immune system in the sense of autoimmune appearance. The disease can be joined with other autoimmune diseases such as vitiligo, atopic dermatitis, Hashimoto thyroiditis and inflammatory intestinal disease.

Clinical picture

On the scalp, the chin, eyebrow, eyelashes and/or pubic hair there is a development of round or oval clearly defined plates from 1 up to several centimeters in diameter where hair is completely missing, and the skin is normal in color and without signs of inflammation. In the active phase of sickness, the hair is easily pulled out on the edge of the diseased plates. In severe forms of the disease, the hair is pulled out from remote, clinically unchanged areas, which is a bad prognostic sign. One or many areas without hair can appear. If alopecia is spread along the nape area it is called ophiasis and is a sign of a severe form of AA.

Alopecia totalis is a complete loss of hair, while the body hair is preserved. Alopecia universalis is the most severe form of the disease where the hair is missing from all over the body. In these two forms of alopecia a spontaneous hair growth rarely occurs.

Within the disease there can be changes on the nails in the form of linear rugosity and spotted depressions.

The course of illness is unpredictable. The first attack with the appearance of the new areas without hair can last from several months to a year, rarely longer.

A recurrence of AA is common and 7  –  10 % of the patients have a chronic form of the disease. The prognosis is worse in alopecia totalis, alopecia in the nape region, the form of disease that started before puberty, in persons with atopic constitution and in persons that have changes in nails. In easier, more limited forms of disease the hair grows spontaneously after 3 to 5 months.

Treatment

In localised form of disease good therapeutic results can be achieved, and in certain number of patients there is a spontaneous growth of hair after a few months. In local therapy, the following products are used: local or intralesional corticosteroid mixtures, topical irritants (cignolin 0.5 – 1%, anthralin, tazarotene, azelaic acid), minoxidil solution and calcineurin inhibitors (pimecrolimus and tacrolimus). In general therapy the following products are applied: PUVA and in severe forms of the disease corticosteroid and cyclosporine.

MA.Sci.Med.Dr. Danica Milobratovic, dermatologist
Dermatological clinic DERMATIM, Belgrade, Serbia