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The typical pattern is one or more bald patches appear on the scalp or any other part of the body. These tend to be around in shape, and about the size of a large coin. A family member, friend, or hairdresser may be the first person to notice the bare patch or patches. Apart from the hairless patch, the scalp usually looks healthy. In few cases, the patient may feel redness, scaling, mild burning, or a slight itchy feeling on an affected part. Quite often the bald patch or patches re-grow hair within a few months. If hair grows back it may not have its primary color and looks grey or white. The original color eventually returns after several months. Sometimes, the initial hairless patch re-grows hair whilst a new bare patch is developing. Often several small hairless patches develop and merge into a larger bald area. Patches on body hair, beard, eyebrows, or eyelashes can be seen in some cases. Large bald patches develop in some people. Whole scalp hair loss is known as alopecia totalis and complete body hair loss is known as alopecia universalis. The nails are affected in about one in five cases and can become pitted or ridged. When a bald patch first develops, it is difficult to predict how it will progress. In some patients, cyclical or seasonal pattern is also seen.
However this type of pattern is rare and difficult to treat. Alopecia areata behaves in a different way in every patient. When a bald patch first develops, it is difficult to predict how it will progress. However here are a few classifications of how it may progress.
A small, round, non - scarring smooth patch which can be seen on any part of the body. When a bald patch first develops, it is difficult to predict how it will progress. There is no perfect diagnostic test for alopecia areata through which we can find out the perfect trigger factors.
In a few patients of alopecia areata, patches can be seen on facial hair like beard or mustache which is known as alopecia barbae. Compare to scalp, alopecia barbae takes more time to be healed. In some individual, alopecia barbae can be seen along with alopecia areata on the scalp.
Patient with repeated transient alopecia areata but never converts into alopecia totalis. The hair loss in these patients lasted longer than those with primary alopecia areata and sometimes associated with seasonal recurrences. In a few patients, the initial hairless patch re-grows hair whilst a new bare patch is developing.
In a few patients, complete scalp hair loss can be seen but other parts of the body are unaffected. This type of hair loss is known as alopecia totalis. Alopecia totalis is very difficult to treat however hair follicles always remain to live in such conditions so re-growth can be seen at any stage of life.
In a few patients, several small hairless patches develop and merge into a larger bald area. It could be a highly progressive phase and some of them may convert into alopecia totalis or alopecia universalis. Those patients who find the presence of regenerated vellus hairs in a few areas after few months have good prognosis.
Ophiasis type of alopecia areata shows a band like hair loss. It occurs mostly in the temporal regions of the scalp and is therefore more difficult to treat, as most medicines have a delayed action on these areas. Usually it starts from the back of the head and then spreads towards the sides and up above the ears.
In a few chronic cases of alopecia areata, nail involvement can be seen. Brittleness, fragility, and pitting of the nail can be seen in those group of patients who have been suffering from alopecia areata for many years or the condition has converted into alopecia universalis.
This is an extreme stage of alopecia areata. In such conditions, entire body hair loss can be seen including eyebrows, eyelashes, mustache, beard, and other parts of the body. Alopecia universalis is extremely difficult to treat. The prognosis will be poor if the patient is suffering from this condition for 3 years or more time.
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