From the Guidelines
The workup for alopecia areata should begin with a thorough clinical examination of the scalp and hair loss pattern, looking for characteristic smooth, round patches of hair loss without scarring, and a detailed medical history should be obtained, focusing on autoimmune conditions, family history of alopecia or autoimmune diseases, recent stressors, and medication use. A thorough clinical examination is essential to diagnose alopecia areata, and it should include a scalp examination and a review of the patient's medical history 1. The hair pull test can be performed at the periphery of lesions to assess disease activity.
Key Components of the Workup
- A dermoscopy examination is valuable, typically revealing yellow dots, black dots, broken hairs, and exclamation mark hairs which are pathognomonic for alopecia areata.
- In uncertain cases, a 4mm punch biopsy from the active border of a lesion can confirm the diagnosis, showing peribulbar lymphocytic infiltration ("swarm of bees" appearance).
- Laboratory testing is not routinely necessary but may include thyroid function tests, antinuclear antibodies, and complete blood count if other autoimmune conditions are suspected.
- Screening for vitamin D, iron, zinc, and thyroid abnormalities may be considered as deficiencies can exacerbate hair loss.
Importance of Counselling
Counselling is an essential part of the workup, as some patients are profoundly upset by their alopecia and may require psychological support 1. Contact with other patient experts and patient support groups can help individuals cope with the changing aspects of alopecia and provide support to find a new level of self-acceptance of their altered body image.
Treatment Considerations
Treatment options, such as topical corticosteroids, should be discussed with the patient, including the potential benefits and risks, such as folliculitis, a common side-effect of treatment with potent topical steroids 1. The patient should be forewarned of the possibility of relapse following or during initially successful treatment.
From the Research
Workup for Alopecia Areata
The workup for alopecia areata typically involves a combination of medical history, physical examination, and diagnostic tests.
- Medical history: to determine the extent and duration of hair loss, as well as any associated symptoms or medical conditions 2
- Physical examination: to assess the pattern and extent of hair loss, and to rule out other potential causes of hair loss 2
- Diagnostic tests: such as blood tests to check for underlying medical conditions, and scalp biopsies to confirm the diagnosis of alopecia areata 2
Treatment Options
Treatment options for alopecia areata include:
- Topical corticosteroids: such as clobetasol propionate, which have been shown to be effective in promoting hair regrowth in some patients 3, 4
- Systemic steroids: such as prednisone, which may be used in more severe cases of alopecia areata 5
- Topical minoxidil: which may be used to help maintain hair regrowth after treatment with systemic steroids 5
- Bimatoprost: a relatively newer treatment option that has been shown to be effective in promoting hair regrowth in some patients 6
- Janus kinase inhibitors: a new emerging concept and therapeutic approach for the treatment of alopecia areata 2
Efficacy and Safety of Treatment Options
The efficacy and safety of treatment options for alopecia areata vary:
- Clobetasol propionate foam has been shown to be effective and safe in promoting hair regrowth in patients with alopecia areata, with a good cosmetic acceptance and patient compliance profile 3
- Systemic steroids have been shown to be effective in promoting hair regrowth in some patients, but may have significant side effects such as weight gain and mood changes 5
- Bimatoprost has been shown to be effective in promoting hair regrowth in some patients, with fewer side effects compared to clobetasol propionate 6