16 - 87 - ALOPECIA AREATA Flashcards
most common form of hair loss in children
Alopecia areata
Of patients with alopecia areata, how many % develop hair loss of their entire scalp hair (alopecia areata totalis)?
5%
Of patients with alopecia areata, how many % develop alopecia areata universalis (loss of total body hair)?
1%
Nail changes of AA include
pitting or sandpaper nails
Loss of total body hair
alopecia areata universalis
Characteristic hallmarks of alopecia areata
black dots (cadaver hairs, point noir), resulting from hair that breaks off by the time it reaches the skin surface
Alopecia areata has been described in association with a variety of other disorders, including ..
cataracts, thyroid disease, vitiligo, atopic dermatitis, psoriasis, Cronkhite-Canada, and Down syndrome
dermoscopic findings of AA
- presence of follicular ostia
- presence of either follicular ostia
- exclamation point hair
- cadaver hair (residual hair shafts visible as black dots in the follicular ostia)
- yellow dots
- characterized by sudden whiting of the hair
- In this case, all pigmented hairs fall out and the patient is left with only white hair
canities subita
histopath findings of AA
- marked increase in catagen and telogen hair follicles
- acute phase: peribulbar immune infiltrate centered around the hair bulb which has been described as a “swarm of bees”
clinical course of AA
- The course of the disease is very variable and characterized by an irregular relapsing course, with approximately 25% of affected individuals having a solitary episode.
- Spontaneous regrowth of hair is common.
- Different body areas appear to regrow independently.
- Approximately 60% of patients have at least a partial regrowth by 1 year, but this is often followed by repeated episodes of hair loss.
- Approximately 40% of the relapses occur within the first year, but a large percentage of patients may relapse after 5 years.
- Hair can regrow white but may change to the patient’s natural color over time.
Poor prognosis associated with AA
- involvement of the occiput and/or hairline,
- chronic relapsing course,
- presence of nail changes,
- when onset is in childhood
The number of patients progressing to alopecia areata totalis is higher in what age group and location?
higher in the younger age groups, and in patients with hair loss from the trunk and extremities
Treatment algorithm for alopecia areata
dose and interval of Intralesional corticosteroid
- Triamcinolone acetonide is used at concentrations from **2.5 to 10 mg/mL. **
- Treatment is repeated every 4 to 6 weeks
- the total amount injected per session varies from 15 to 40 mg
- An initial response is often seen after 4 to 8 weeks.
If no regrowth can be seen after how many months of IL injections, other treatment options should be considered
4 months
how do you apply anthralin
- Anthralin is used as a **0.2% to 1% cream or ointment. **
- It is usually applied daily to the affected scalp areas and left on for 20 to 30 minutes for the first 2 weeks, and then for 45 minutes daily for 2 weeks, up to a maximum of 1 hour daily.
- Some patient may tolerate overnight therapy.
- When therapy is effective, new hair growth can usually be seen after 2 to 3 months of treatment.
- Patients should be cautious **not to get anthralin in the eyes **and to protect the treated skin areas from ultraviolet radiation.
- **Brown discoloration **of the treated skin and brown staining of clothes and linen may occur.
- The patient should be advised to rinse off the anthralin with cool or lukewarm water, as hot water increases the likelihood of brown stains of tiles and bathtub.
Anthralin is not suitable for the treatment of what areas?
eyebrows and beard
desired effect of the treatment using topical immunotherapy
creation of a contact dermatitis
most commonly used contact sensitizer for topical immunotherapy
Diphenylcyclopropenone
- Diphenylcyclopropenone is compounded in an acetone base and stored in opaque bottles to protect the solution from photodegradation.
- Applying a small amount of a **2% solution **to a small scalp area 1 week prior to treatment start, sensitizes the patient.
- The diphenylcyclopropenone solution is then applied weekly to the scalp, starting at a concentration of 0.0001%.
- The scalp should not be washed for 48 hours after treatment and should be protected from ultraviolet radiation.
- Carefully increase the concentration every week until the patient develops a mild erythema and mild itching.
- The treatment is continued with this concentration; the usual highest concentration used is** 2%.**
side effects of Diphenylcyclopropenone
- lymphadenopathy in 100% of patients,
- **severe contact eczema, **
- discoloration of the skin including vitiliginous patches and hyperpigmentation on the scalp and other parts of the body
