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| Alopecia Areata - Patchy Hair Loss Alopecia Areata (AA) is considered an autoimmune disease that affects 1% of the population. It usually presents with an oval patch or multiple confluent patches of asymptomatic nonscarring alopecia. Twenty percent of cases may proceed to alopecia totalis, affecting the entire scalp. One percent may go on to alopecia universalis, affecting all body hairs, including eyebrows and eyelashes. The disease frequently clears up spontaneously within 1 year. Recurrences, however, are common. Severe disease has less of a tendency to clear up on its own, especially in children or atopic individuals. Frequently, fingernails may show dystrophic changes such as pitting, ridging, and thinning of the nail plate. Treatment options Treatment depends on the extent of the disease and the age of the patient. For small patchy disease, intralesional corticosteroid is the treatment of choice. Triamcinolone acetonide (Kenalog®) suspension 5 mg per mL is injected with a 30-guage needle directly into the patches with tiny injections of 0.1 mL each spread over affected areas. The total amount should not exceed 10 mg of triamcinolone acetonide per visit. Injections are repeated every four to six weeks. Other options include topical minoxidil, anthralin, and steroid. For more extensive disease, the use of a contact allergen (diphencyprone) is the treatment of choice, with some studies showing 40% success rates. Diphencyprone is readily available in Canada and Europe, but is difficult to obtain in the United States. Other treatment options include psoralens and ultraviolet A radiation (PUVA) and the use of systemic steroids. The use of systemic steroids is controversial however, since steroids have a high side effect profile and patients may have to take the drug for a long time. Usually when the systemic steroid is discontinued, hair shedding recurs.
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