Alopecia area (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 totalis, affecting all body hairs, including eyebrows and eyelashes. The disease frequently resolves spontaneously within 1 year. Recurrences, however, are common. Severe disease has less of a tendency to resolve 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 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 4 to 6 weeks. Other options include topical minoxidil, anthralin, and steroid. For more extensive disease, the use of a contact allergen (diphencyprone) is treatment of choice, with some studies showing 40% success rates. Diphencyprone is difficult to obtain in the United States but is more readily available in Europe and Canada. Other treatment options include psoralens and ultraviolet A radiation (PUVA) and the use of systemic steroids. The use of systemic steroids is controversial, since steroids have a high side effect profile and patients may have to be on the drug for a long time. Usually when the systemic steroid is discontinued, hair shedding occurs.

Patients with AA require encouragement and emotional support. Many cities now have support groups, which are invaluable to a large number of patients. The National Alopecia Areata Foundation, 710 C Street #11, San Rafael, California 94901-3853, is an excellent resource for patients.

A patch of alopecia which covers the periphery of the scalp like a turban.

Well circumscribed patch with exclamation point hairs.