utd_medknow
International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
 
 
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   
 


 
 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 6  |  Issue : 4  |  Page : 190-191  

An unusual pattern of alopecia areata


Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India

Date of Web Publication14-Oct-2014

Correspondence Address:
Aayush Gupta
Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.142893

Rights and Permissions

How to cite this article:
Gupta A, Sharma YK, Dash K, Prakash N. An unusual pattern of alopecia areata. Int J Trichol 2014;6:190-1

How to cite this URL:
Gupta A, Sharma YK, Dash K, Prakash N. An unusual pattern of alopecia areata. Int J Trichol [serial online] 2014 [cited 2022 Jun 26];6:190-1. Available from: https://www.ijtrichology.com/text.asp?2014/6/4/190/142893

Sir,

Alopecia areata (AA) - the most common T-cell-mediated autoimmune loss of hair of all colors associated with collapse of hair follicle immune privilege - has a 2% lifetime risk, [1] and a peak incidence between the second and fourth decades of life. [2] The typical AA patient most often presents with one or a few, nonscarred, round or oval, sharply demarcated alopecic patches involving - in decreasing order of frequency - scalp, beard, eyebrows and eyelashes. Its variants involving scalp entirely (alopecia totalis) or as patterned (sisaipho and ophiasis) are unusual and involving all hair bearing sites (universal AA), uncommon. [3] We present a case of "extensive" AA that retained hair only on vertex of scalp, confounding us regarding its precise type.

A 29-year-old male presented with history of loss of hair 6 months ago commencing as a small patch over the occiput and gradually extending not only over the entire circumference of scalp (except the vertex) but also relentlessly progressing over all other hair bearing areas. This hair loss was unassociated with itching/burning or any other systemic complaints. Dermatological examination revealed diffuse non-scarring loss of hair from the entire body except the vertex of the scalp [Figure 1] and [Figure 2], hair pull test on which was negative. Nails revealed fine pitting. General physical - and systemic examinations were normal. Administration of four, monthly dexamethasone cyclophosphamide (DCP) pulses revealed no hair regrowth. Unfortunately, the patient got lost to follow-up.
Figure 1: Non-cicatricial alopecia involving scalp, eyebrows, eyelashes, beard, moustache, nose, ears and upper chest

Click here to view
Figure 2: Non-cicatricial alopecia involving the occiput and suprauricular areas

Click here to view


Alopecia areata can be classified into many subtypes; patchy AA (75%) being the most common. A subset of patients (10-20%) suffer from alopecia totalis losing all scalp hair; others, develop universal AA losing hair from all sites including eyebrows, eyelashes, nose, and ears. A special band-like pattern of AA, usually recalcitrant to treatment, winding along the occipital hairline extending toward the temples has been called ophiasis; in its inverse, sisaipho, type hair are lost centrally and spared at the margins frontoparietooccipitally mimicking androgenetic alopecia. In diffuse AA, more common in women aged over 20, diffuse sudden hair loss-evolving totally in less than 3 months and regrowing totally in 5-9 months - extends over the whole scalp but usually does not affect all sites; hair pull test is positive. Rectangular occipital AA - paraneoplastic association with diffuse lymphoma, alveolar soft tissue sarcoma, etc. - affects occipital region and sometimes, supraauricular area. [4]

Complete loss of scalp hair is common to total AA as well as universal AA. Our patient had a complete loss of body hair with retention of just the hair on vertex of his scalp, thereby confounding us as regards the precise type of alopecia wherein extension of his near universal alopecia, somehow, did not involve vertex of the scalp for at least 8 months, 4 months before and 4 months after DCP therapy. We failed, despite a diligent search of the literature, to find a similar case and reason, if any, for this prolonged retention of hair only on the vertex of scalp despite progressive alopecia at all other sites. Hence we continue to wonder and are at a loss whether this interesting presentation of AA was extensive ophiasis along with alopecia of other hair bearing sites or a unique pattern of AA!

 
   References Top

1.Finner AM. Alopecia areata: Clinical presentation, diagnosis, and unusual cases. Dermatol Ther 2011;24:348-54.  Back to cited text no. 1
    
2.Nonomura Y, Otsuka A, Miyachi Y, Kabashima K. Case of intractable ophiasis type of alopecia areata presumably improved by fexofenadine. J Dermatol 2012;39:1063-4.  Back to cited text no. 2
    
3.Priego-Recio CM, Rodríguez-Pichardo A, Camacho-Martínez FM. Unusual forms of alopecia areata in a Trichology Unit. J Eur Acad Dermatol Venereol 2013.  Back to cited text no. 3
    
4.Kavak A, Yesildal N, Parlak AH, Gökdemir G, Aydogan I, Anul H, et al. Alopecia areata in Turkey: Demographic and clinical features. J Eur Acad Dermatol Venereol 2008;22:977-81.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed2805    
    Printed54    
    Emailed0    
    PDF Downloaded56    
    Comments [Add]    

Recommend this journal