From the Guidelines
Alopecia areata can present at any age, with no known race or sex preponderance, and often appears as patches of hair loss on the scalp or any hair-bearing skin. The onset of alopecia areata is highly variable, and it can affect individuals of all ages, as reported in the guidelines for the management of alopecia areata 1. Some key points to consider when evaluating the presentation of alopecia include:
- The affected skin may be slightly reddened but otherwise appears normal
- Short broken hairs (exclamation mark hairs) are frequently seen around the margins of expanding patches of alopecia areata
- The nails are involved in about 10% of patients referred for specialist advice, as noted in the study published in the British Journal of Dermatology 1
- Data from secondary and tertiary referral centres indicate that 34–50% of patients will recover within 1 year, although almost all will experience more than one episode of the disease 1 The prognosis is less favourable when onset occurs during childhood and in ophiasis (alopecia areata of the scalp margin), highlighting the importance of early recognition and treatment to improve outcomes in many forms of hair loss.
From the Research
Presentation of Alopecia
- Alopecia areata is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss 2.
- The disease can affect all hair-bearing sites, with patchy alopecia areata affecting the scalp being the most common type 3.
- Alopecia totalis (AT) and alopecia universalis (AU) involve complete loss of the scalp and body hair, respectively, and are considered the most severe subtypes of alopecia areata 4.
Age and Sex Distribution
- Alopecia areata affects nearly 2% of the general population at some point during their lifetime, with no specific age or sex distribution mentioned in the studies 3.
- However, a study found that the prevalence and incidence of AA and AT/AU were higher among female vs male individuals, adults vs children and adolescents 4.
Onset and Progression
- The studies do not provide specific information on when alopecia typically presents, but it is mentioned that the disease can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety 2.
- A review of treatment for alopecia totalis and alopecia universalis found that management of AT and AU can be challenging, and although multiple treatment modalities have been explored, no therapy is currently FDA-approved 5.
- Long-term outcomes of AT and AU are generally poor, with only 8.5% of patients achieving complete recovery 6.