Alopecia

INTRODUCTION: Alopecia is a medical terminology which is being used for various types of hair loss like androgenic alopecia, alopecia areata, cicatricial alopecia, trichotillomania, traction alopecia etc. But among all, alopecia areata is a highly unpredictable, autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body.
Perfect etiology of alopecia areata is still not known. Medical science believes that the affected hair follicles are mistakenly attacked by a person's own immune system (white blood cells), resulting in the arrest of the hair growth stage. Alopecia areata usually starts with one or more small, round, smooth bald patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis).

• Hairs are keratinized elongated
• structures derived from invaginations of
• epidermis and project out from most of
• the body surface.

RACIAL PREVALENCE

• Whites are hairiest.
• Asians are least hairy and
• blacks fall in between.

TYPES OF HAIR
Morphologically
Straight :         Asians , whites.
Spiral    :          Blacks, whites.
Helical :          Whites.
Wavy   :          Whites.

Fetal hair - Lanugo  hair : soft, fine, lightly pigmented hairs.
Adult hair -
Vellus hair  :   fine hairs cover most of the body  of youngsters and adults.
Terminal hair: long, coarse, pigmented hairs with larger diameters.

NUMBER OF HAIRS
Scalp : about 1,00,000 hairs.
Face  : about 600 hairs /cm2.
Rest of the body : about 60 hairs/cm2.

LENGTH, WIDTH AND GROWTH RATE

Length : range from <1mm to > 1 meter.
Average uncut scalp hair : 25 – 100 cm. (exceptionally 170 cm)
Width : from 0.005 to 0.06mm.
Growth rate: about 1 cm/ month (terminal hair).

FUNCTIONS
1.   Protects body surface from external injury.
2    Helps in sensory function.
Psycho – social importance.
Forensic importance.
i. Identification of race, sex, age and religion.
ii. Cause of death- can be determined.
iii. Time of death- can be determined.

5. Assist thermo- regulation: mainly in lower animals.
 
PATHOLOGY

• Absence or loss of hair especially of the scalp.
• Pathophysiology of hair loss :

1. Production failure

• Failure to produce or continue to
• produce a normal hair follicle.

2. Aberration of –

• Normal hair cycle.
• Production of a normal hair shaft.

3. Destruction of –

• Hair follicle.

CLINICAL FEATURE

• Rapid and complete loss of hair in one or several patches.
• Site – Scalp, bearded area, eyebrows, eye lashes and less commonly other areas of body.
• Size – Patches of 1-5 cm in diameter. “Exclamation point” hair- at the periphery of hair loss, there are broken hairs, whose distal ends are broader than the proximal end.
• Few resting hairs may be found within the patches.
• “Going gray overnight”- a mysterious phenomenon is observed in fulminant alopecia areata.
• In about 10% cases of long standing extensive alopecia areata, some nail changes develop.
• Alopecia totalis” – Total loss of scalp hair.
• “Alopecia universalis” – Loss of entire body hair including scalp hair.
• “Ophiasis” – Loss of hair confluent along the temporal and occipital scalp.
• “Sisaipho”- Loss of hair of entire scalp except temporal and occipital area.

DIFFERENTIAL DIAGNOSIS

1. Tinea capitis.
2. Trichotilomania.
3. Secondary syphilis
4. Congenital triangular alopecia.
5. Alopecia neoplastica.
6. Early lupus erythematosus.

MANAGEMENT
 
Homeopathy can help for  ALOPACIA falling of hairs can be stopped with homeopathic medicines