There are several different types of alopecia areata presentation

Alopecia areata hair loss information for men and women
Alopecia Areata 
Alopecia Areata Biology
Alopecia Areata Treatments

  Types of Alopecia Areata
When there are patches of scalp or other parts of the body that are completely hairless, it is generally a case of alopecia areata. It is a non-scarring, inflammatory disease in which there is complete hair loss. Alopecia areata may affect men, women and children alike. Although this is not a life threatening disease, alopecia areata often has severe psychological and sociological implications, as at times the condition can result in complete hair loss and cause disfigurement.

The Hair Follicle Cycling

There are usually three stages in hair follicle growth in mammals – anagen, catagen and telogen. Anagen is the period of active growth. This is followed by a period of apoptosis or regression. Finally there is telogen or a period of rest before the next phase of anagen begins. In this phase generally the hair fiber is shed.

Causes of Alopecia Areata

When the anagen hair follicles are damaged, it may result in alopecia areata. It has been observed that anagen hair follicles sometimes enter the telogen state prematurely, causing alopecia. When this condition occurs repeatedly, poor aberrant hair fibers are produced from dystrophic anagen follicles. Scientists have two views on the state of the hair follicles in alopecia areata. Some believe that the hair follicles transit rapidly between dystrophic anagen and telogen stages while another school of thought believes that they are arrested in a state of telogen.

Thus in early alopecia areata, the disruption of the normal hair follicle cycling results in a disproportionate ratio of anagen, catagen and telogen hair follicles resulting in clusters of telogen hair falling off from the scalp and other parts of the body. The hair shafts that fall off appear to have roots that indicate telogen hair follicles. At the periphery of the bald patch are found fractured hairs with sharp pointed tips. They are called exclamation mark hairs because they resemble exclamation marks.

Types of Alopecia Areata

On clinical examination, alopecia areata appears as a smooth bald patch, which at times may further expand in size. Similar bald patches may appear subsequently in other areas. Alopecia areata has been classified into different types according to the severity of the disease and its various forms.

  1. Alopecia Totalis: In this the scalp is affected and all the hair from the scalp is lost resulting in a smooth bald head.
  2. Alopecia Universalis: This is a severe form of alopecia where there is loss of all body and scalp hair including eyebrows, eyelashes, underarms and pubic hair.
  3. Alopecia Areata Barbae: When alopecia affects the hair of the beard region, it is known as alopecia areata barbae.
  4. Reticulated Areata Barbae: In this form of disease, bald patches may not be found but there is hair loss in irregular patterns in a net like fashion. In the scalp, there are regions of hair loss interspersed with areas with normal hair growth. When affected with reticulated alopecia, patients may have hair falling from one region but new hair growth in another region. This phenomenon may for many months or years.
  5. Ophiasis type of alopecia areata shows a band like hair loss. It occurs mostly in the temporal or the occipital regions of the scalp and is therefore more difficult to treat, as most medicines have a delayed action on these areas. Ophiasis type of alopecia is identified by a turban or snake like pattern on the periphery of the scalp. Ophiasis in Greek means serpent and this is how the disease gets its name.
  6. Diffusion Type of Alopecia Areata: In this case, there is a premature cessation of anagen growth, which causes partial hair loss throughout the scalp. No distinct patches are evident. It may not be possible to identify the disease clinically, as it can be mistaken for telogen hair loss, which is diffused hair loss caused by stress, certain physical conditions like puberty or childbirth, chronic illness, or trauma. It is also similar to anagen effluvium, which is hair loss in the anagen stage due to chemotherapy or radiation treatment. In some cases of hair loss on top of the head, it also resembles typical male or female pattern of hair loss or even trichotillo where people pull out their own hair. A biopsy is perhaps the best way to diagnose the disease specifically. Dermatologists also look for the exclamation type of broken hairs as indication of alopecia areata.
  7. Perinevoid Alopecia Areata: This is a relatively unusual type of alopecia areata where spots of skin are found having properties different from the surrounding general skin area. Around these pigmented spots or nevi are found patches having characteristics of alopecia areata.

Ikeda Classification of Alopecia Aerata Types

Ikeda has broadly classified alopecia areata into type I, type II, type III and type IV categories under which each of the above forms of alopecia areata can be categorized. The Ikeda type of classification is as follows:

  • Type I – This consists of 80% of alopecia areata cases. People with type I alopecia areata had round bald patches with no previous family history of the disorder. They usually did not suffer from additional conditions like hypertension or endocrinal disorders.
  • Type II – Individuals with type II alopecia areata usually carried a history of asthma, allergic rhinitis or dermatitis. The alopecia is generally seasonal and causes a longer period of hair loss. The hair loss pattern is usually ophiasis, reticular or round. The patch may even have an intermediate shape. 75% of such patients finally ended up with alopecia totalis.
  • Type III – This form of alopecia areata has a frequency of 4%. Patients with type III alopecia areata have chronic disease activity and a history of parental hypertension. The alopecia is of a reticular pattern and 39% of the patients usually develop alopecia totalis.
  • Type IV form of alopecia areata usually develops in people over 40 years of age. They have a round, reticular or ophiasis pattern of alopecia, which usually remains for a prolonged period of time, finally leading to alopecia totalis in 10% of the group.

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