Alopecia Signs and Symptoms

Introduction

• May be localized (patchy) or generalized
• Scarring or non-scarring
  • Scarring alopecia from severe inflammation of the hair follicle result in irreversible damage
  • Non-scarring alopecias are reversible

• Abrupt or gradual onset
• Most common causes include androgenic/androgenetic alopecia (male and female pattern baldness) and alopecia areata
• History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness and stress factor
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Definition

• Autoimmune non-scarring hair follicle disease characterized by patches of significant hair loss

• A chronic follicular disorder characterized by progressive hair loss with a patterned distribution
• Alopecia totalis mimics androgenic alopecia

Signs and Symptoms

• Hamilton-Norwood staging (male pattern hair loss [MPHL])
  • The higher the stage, the more severe the hair loss
  • Usually starts with bitemporal recession of frontal hairline and continuing with thinning over the vertex, eventually complete hair loss on the vertex; bald hair
  • The bald patch enlarges and joins the receding frontal hairline
  • Other patterns may develop, but it is the androgenic-independent hair (on the sides and back of scalp) that do not thin

• Ludwig staging (female pattern hair loss [FPHL])
  • Marked presence of miniaturized, vellus-like hair follicles
  • The higher the stage, the more severe the hair loss
  • Thinning usually diffuse, but more marked on the frontal and parietal regions; “monk’s haircut” in severe cases

• Christmas tree pattern
  • Another female hair loss pattern with centroparietal thinning and frontal accentuation

• Thinning of the hair begins between 12-40 years for MPHL
• Chronic progressive diffuse hair loss in their 20’s and 30’s for FPHL

• Non-scarring with hairs located at the periphery of the patch extending a few millimeters above the scalp (“exclamation mark”) hair
• Nail dystrophy occurs in 10%
  • Pitting with irregular pattern or organized transverse or longitudinal rows, concave dorsal nail plate, etc
• Clinical forms:
  • Patch alopecia areata: Circumscribed areas of alopecia (patches), which may be oval, rounded, single, or multiple
  • Total alopecia areata (alopecia totalis): 100% loss of scalp hair
  • Universal alopecia areata (alopecia universalis): 100% loss of hair on scalp and body
  • Diffuse alopecia areata: Hair loss resulting in overall decrease in density and distributed all over the scalp, without patches
  • Acute diffuse and total alopecia: Acute onset of diffuse hair loss, usually progressing to total alopecia areata within 3 months

• Most patients are <40 years of age