Classification Of Alopecia Areata By Clinical Types And Associated Conditions
Type I Alopecia Areata (Patchy, 83%) – This is the most common type presenting with round, patchy hair loss (alopecia). The best chance of spontaneous regrowth is after the initial episode, or with treatment of subsequent episodes. This type will present with no family history of hypertension, allergic conditions (atopy), autoimmune or endocrine disorders. It usually affects older children or adults between 20-40 years old. Only 6% develop total hair loss (AT). If the AA develops before puberty, the more likely is will be to have persistent and/or severe alopecia
Type II Alopecia Areata (Atopic type, 10%) - Type II may be round/annular with or without simultaneous regrowth (reticular). It may also present with ophiasis (above ears, posterior neck, or indeterminate shapes Patients with Type II AA typically have a history of asthma, allergic rhinitis or dermatitis (eczema). This the of AA lasts longer than Type I, and is associated with seasonal recurrences. Thirty three - 75% of Type II AA may develop total hair loss of scalp (AT), but this is dependent upon nationality.
Type III (Prehypertensive type, 4%) - This is classified by chronic hair loss at new sites and regrowth at old sites (reticular). In this case, 95% of patient’s parents had hypertension - Type I (10%), Type II (11%), General population (21%). Type III AA usually occurs in young adults, and 20-39% may develop total hair loss of scalp (AT)
Type IV (Endocrine-Autoimmune, 3%) - Sufferers from Type IV AA may have prolonged round/patchy lesions, simultaneous loss and regrowth at different sites, ophiasis or indeterminate hair loss that becomes total scalp hair loss in 10% of patients. Patients are also usually over 40 years of age with multiple medical conditions in which the treatment may affect hair loss. Only 3-10% of Type IV AA may develop total hair loss (AT)
Alopecia areata is an inherited autoimmune disease causing non-scarring hair loss. Alopecia areata often spontaneously disappears without treatment.
There are many factors that may contribute to Alopecia areata. Stress, including anything from a death in family or loss of job, to financial problems and family hardships; infections of the skin, sinus, ears, teeth, kidney or bladder; inflammation including arthritis, asthma, atopic dermatitis/eczema; or certain types of autoimmune diseases such as Adrenal (Addison) pernicious anemia, thyroiditis or narcolepsy can all lead to the development of Alopecia areata. It is also an inherited condition associated with Downs Syndrome.
Alopecia areata can affect one site - usually the scalp - or affect multiple sites, usually presenting as a round/annular patch of hair loss. Although scalp hair loss is most common, loss of eyebrows, eyelashes, beard or other body sites may be only site of alopecia areata. Also, ridging or pitting of finger nails is seen less often in alopecia areata but does occur.
Information on Research and Causes of Alopecias
In the past 20 years, medical research has made significant advances in determining the genetic and environmental causes of a number of human diseases including some causing hair loss. The US National Institute of Health (NIH) in particular has freely available sites to educate the public about medical advances for the diagnosis and treatment of common and rare diseases. The National Organization for Rare diseases (NORD) (www.rarediseases.org) is a helpful source of information. Since medical research on alopecias and hair disorders may be very difficult to understand, there are a number of websites created by hair disorder associated support groups.
Alopecia areata is one of more than 80 autoimmune diseases including rheumatoid arthritis, celiac disease, thyroiditis, early onset insulin dependent diabetes mellitus and lupus erythematosus. The National Alopecia Areata Foundation (NAAF) (www.naaf.org) is a non-profit support group that provides information about and research support for patients with alopecia areata.
NAAF and NIH supported an Alopecia Areata Registry research grant to identify families and individuals with alopecia areata to enable medical researchers to identify specific genetic changes that will lead to better diagnoses and therapies. The impact on these and other medical conditions by studying alopecia areata, a distinctive and visible condition, is easy to understand but not rarely appreciated by the general public.
A similar non-profit support group, Cicatricial Alopecia Research Foundation (CARF) (www.carfintl.org) provides information and raises funds to support research on permanent scarring forms of alopecia.
Definitions of Clinical Features of Alopecia Areata
Patchy – Annular (Round) - May occur on any body site but most commonly on the scalp.
Chronic Active, Patchy - Patchy with simultaneous loss and regrowth (reticular) or indeterminate.
Ophiasis – Band-like hair loss over the ears and/or posterior neck.
Diffuse type – Thinning of the hair over the entire scalp without smooth round bald spots.
Totalis type (AT) – Smooth, completely bald scalp.
Universalis type (AU) – Total hair loss of scalp and one or more other body sites such as loss of eyebrows or lashes, beard, trunk, axilla, extremities, genital area. These may also occur prior to scalp hair loss
Alopecia areata can even lead to total body hair loss. This is not necessarily permanent, although hair will rarely regrow without treatments. The longer the severe type of alopecia areata persists, the less likely it will completely regrow. Patchy alopecia areata (Type I) can recur due to associated “triggers.” Sometimes these triggers are obvious; sometimes they are unknown. Common triggers include: asthma, autoimmune diseases, atopic dermatitis (eczema), infections, seasonal allergies (hay fever, rhinitis), sinusitis, thyroiditis, and some irritant or fragrant soaps and shampoos.
