Alopecia areata Lidia Rudnicka Department of Dermatology, Medical University of Warsaw Poland lidiarudnicka@gmail.com I have no relevant conflicts of interest
anagen phase Hair cycle telogen phase catagen phase
anagen effluvium Anagen effluvium occurs after any insult to the hair follicle that impairs its mitotic activity . Causes: Inflammatory (alopecia areata) Drug-induced (chemotherapy, retinoids) Toxic (thallium, arsenic) Extreme nutrient deficiencies
High mitotic activity - thick hair Low mitotic activity - thin hair No mitotic activity - no hair
• Common trichoscopy features of AA • Rare trichoscopy features of AA • Trichoscopic cases in AA
Alopecia areata in trichoscopy Exclamation mark hairs Black dots Yellow dots
Multiple exclamation mark hairs = high disease activity
Alopecia areata – tapered hairs Tapered hairs are elongated exclamation mark hairs Inui et al. 2009
Pohl-Pinkus constrictions and monilethrix-like hairs in alopecia areata These hairs differ from true monilethrix by the irregular distribution of constrictions
Alopecia areata – black dots
black dots a marker of high disease activity in alopecia areata but not specific for alopecia areata
Alopecia areata – yellow dots
Yellow dots may not be visible in Asian patients S. Inui . Trichoscopy in Asian Skin in Atlas of Trichoscopy, 2012
• Common trichoscopy features of AA • Rare trichoscopy features of AA • Trichoscopic cases in AA
Alopecia areata – vellus hairs Asian Caucasian Marker of disease severity ? Inui et al
• Trichorrhexis nodosa • Zigzag hairs
Zigzag hairs
Alopecia areata – regrowing hairs 70x circle pigtail
Trichoscopy feature % of patients with AA Yellow dots 63-94% Black dots 44-70% Exclamation mark hairs 30-44% Tapered hairs 12-42% Broken hairs 45-58% Vellus hairs 33-72% Trichorrhexis nodosa 3-16% Monilethrix-like hairs 2-3% Pohl-Pinkus constrictions Regrowing hairs Source: Atlas of Trichoscopy, 2012
• Common trichoscopy features of AA • Rare trichoscopy features of AA • Trichoscopic cases in AA
43 – year old woman Chemotherapy – induced alopecia
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