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afya
Alopecia Areata
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Automimmune - localised well demarcated patch of hair loss may have small broken exclamation hairs ar edge of patch Autoimmune (target hair follicle, trigger unknown) / Atopy may be related - usually worse prognosis relapse and remit any age (starts mostly 15-30 - 60% by 20yrs), M=F hair pull test is positive in active disease hairline involved - worse prognosis nails (pitting) involved in severe disease no mucosal involvement occ diffuse wide-spread thinning most common patchy hair loss in adults not scaly, not inflamed, not scarring, coin sized areas, may involve any hair on body but scalp most common short broken hairs - exclamation mark hairs may occur ''Types'' Localized, diffuse, ophiasis, totalis, universalis Ophiasis - band patturn on sides and back of scalp Poor prognosis - refer to dermatology totalis/universalis/ ophiasis / rapid progressive young age, nail dystrophy, another autoimmune problem 50% regrow by 1yr, 80-90% eventually - therefore careful explanation may be sufficient ''Mx'' - aims for regrowth - doesn't stop new loss Wait - usually regrows in 6-12/12, most 2nd line needs to come from dermatologist Steroids ?2nd line but beware systemic effects ... either topical or intralesional - long term treatment, avoid on face, (topical less effective, can use oral if widespread but ...) 80% respond, half of which will relapse when steroids stopped Topical Minoxidil Dithranol - 2nd line - messy and may cause inflammation Diphencyprone (contact immunotherapy) - 2nd line - contact sensitiser - inducing dermatitis - may encourage hair to grow - 30% respond - less if long term prob, needs week applications for 12-18/12 - useful if total AA Phototherapy - 2nd line - rarely used as long term, difficult in fair skinned, low response rate Wig
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