Highlights & Basics
- Alopecia areata is an autoimmune disease that targets the hair follicle.
- It is characterized by sudden onset of patchy hair loss.
- The diagnosis is clinical. Characteristic physical findings are exclamation point hairs (short, broken hairs tapering proximally at the scalp) and a positive pull test. A scalp biopsy shows perifollicular inflammation.
- Topical or intralesional corticosteroids are appropriate for patients with limited hair loss. Skin atrophy can be a temporary side effect.
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History & Exam
Key Factors
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Definition
Epidemiology
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Citations
Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines: part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440-447.[Abstract]
Hordinsky MK. Medical treatment of noncicatricial alopecia. Semin Cutan Med Surg. 2006;25:51-55. [Abstract]
Messenger AG, McKillop J, Farrant P, et al. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166:916-926.[Abstract]
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2. Cranwell WC, Lai VW, Photiou L, et al. Treatment of alopecia areata: An Australian expert consensus statement. Australas J Dermatol. 2019 May;60(2):163-170.[Abstract][Full Text]
3. Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines: part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440-447.[Abstract]
4. Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015;8:397-403.[Abstract][Full Text]
5. Safavi KH, Muller SA, Suman VJ, et al. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc. 1995;70:628-633.[Abstract]
6. Price VH. Treatment of hair loss. N Engl J Med. 1999;341:964-973. [Abstract]
7. Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42:549-566.[Abstract]
8. Hordinsky MK. Medical treatment of noncicatricial alopecia. Semin Cutan Med Surg. 2006;25:51-55. [Abstract]
9. Norris D. Alopecia areata: current state of knowledge. J Am Acad Dermatol. 2004;51:S16-S17. [Abstract]
10. Green J, Sinclair RD. Genetics of alopecia areata. Australas J Dermatol. 2000;41:213-218.[Abstract]
11. Gilhar A, Ullmann Y, Berkutzki T, et al. Autoimmune hair loss (alopecia areata) transferred by T lymphocytes to human scalp explants on SCID mice. J Clin Invest. 1998;101:62-67. [Abstract]
12. Darwin E, Hirt PA, Fertig R, et al. Alopecia Areata: Review of Epidemiology, Clinical Features, Pathogenesis, and New Treatment Options. Int J Trichology. 2018 Mar-Apr;10(2):51-60.[Abstract][Full Text]
13. Colombe BW, Price VH, Khoury EL, et al. HLA class II antigen associations help to define two types of alopecia areata. J Am Acad Dermatol. 1995;33:757-764.[Abstract]
14. Martinez-Mir A, Zlotogorski A, Gordon D, et al. Genomewide scan for linkage reveals evidence of several susceptibility loci for alopecia areata. Am J Hum Genet. 2007;80:316-328.[Abstract]
15. McDonagh AJG, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002;27:405-409.[Abstract]
16. Goh C, Finkel M, Christos PJ, et al. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol. 2006;20:1055-1060. [Abstract]
17. Han A, Mirmirani P. Clinical approach to the patient with alopecia. Semin Cutan Med Surg. 2006;25:11-23. [Abstract]
18. Tosti A, Torres F. Dermoscopy in the diagnosis of hair and scalp disorders. Actas Dermosifiliogr. 2009;100(suppl 1):114-119.[Abstract]
19. Stein DJ, Hollander E. Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol. 1992;26:237-242. [Abstract]
20. Eudy G, Solomon AR. The histopathology of noncicatricial alopecia. Semin Cutan Med Surg. 2006;25:35-40.[Abstract]
21. Messenger AG, McKillop J, Farrant P, et al. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166:916-926.[Abstract]
22. Khoury EL, Price VH, Abdel-Salam MM, et al. Topical minoxidil in alopecia areata: no effect on the perifollicular lymphoid infiltration. J Invest Dermatol. 1992;99:40-47.[Abstract]
23. Sharma VK. Pulsed administration of corticosteroids in the treatment of alopecia areata. Int J Dermatol. 1996;35:133-136. [Abstract]
24. King B, Ohyama M, Kwon O, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022 May 5;386(18):1687-99.[Abstract]
