ABSTRACT
Alopecia areata is a complex genetic immune-mediated nonscarring hair disease that targets actively growing anagen hair follicles.1 The lifetime risk is estimated to be approximately 2.1%.2 The disease can affect all ethnic groups and both males and females at all ages. Over four and a half million people in the United States are estimated to be affected with alopecia areata (National Alopecia Areata Foundation, www.naaf.org). Alopecia areata typically presents as one of four major patterns:
• Round or oval patches of hair loss (Figure 9.1)
• Loss of all scalp hair (alopecia totalis) (Figure 9.2)
• Loss of all body hair (alopecia universalis)
• Ophiasis pattern alopecia areata (Figure 9.3)
However, patients experiencing spontaneous regrowth or treatment-induced hair regrowth may have vellus or indeterminate hair regrowth present in affected areas and it may be difficult to categorize such patients into the distinct categories noted above. There is currently no drug approved by the Food and Drug
Administration (FDA) in the United States for the treatment of this very common autoimmune disease. To suppress disease activity, physicians commonly prescribe topical or intralesional corticosteroids and, less commonly, oral steroids. There are also many other treatment approaches, and several exciting evolving therapies are currently in clinical trials. As the understanding of alopecia areata advances, physicians and other health care providers will be able to offer patients and their families more
comprehensive information on the epidemiology, pathophysiology, evaluation, andmanagement of alopecia areata. The treatment of this disease is advancing to using more targeted approaches based on biomarker information for individual patients.
