Baldness in Patches

The scalp contains approximately 1,00,000 hairs. Each hair grows for about 1,000 days. The rate of hair loss per day is about 100 normally.

Alopecia areata (also called ‘Pelade’) refers to the absence of the hair from normal hairy area on the skin. It is the patchy, non-scarring hair loss usually from the scalp or other body sites as well. It is an auto-immune disease characterized by single or multiple areas of alopecia without inflammation.

If it involves the whole of scalp it is called alopecia totalis and if it involves the whole of body it is called alopecia universalis.

The disease may occur in both sexes with strong family history of baldness. Males are more commonly affected than females and more in young adults and children.

A syndrome termed Vogt-Koyani-Harada syndrome comprises of alopecia areata, vitiligo and uveitis.

Cause

The cause for the disease is yet unknown (may be auto-immune). It is also sometimes anxiety related. Genetic predisposition is common in children with Down’s syndrome. Greater association is seen in auto-immune disorders like thyroid diseases, vitiligo and diabetes mellitus.

Risk Factors

The common risk factors include positive family history of baldness, physical or psychological stress, pregnancy and poor nutritional status.

Signs

There are no signs of inflammation, scaling or scarring, but the hairs plucked from the bald area are often club hairs and broken hairs in this area resembling exclamation marks. This is diagnostic. Skin of that area is smooth. The scalp may be slightly red but scaling is not a feature.

Treatment

Usually the disease resolves within three years without treatment (self-limiting). However, recurrences are common. Spontaneous re-growth takes about 2-6 months in the majority. Repeated episodes may occur when the prognosis is deemed poor. If required, high potency topical steroids may be prescribed by the dermatologist, which stimulate re-growth of the hairs.