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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