Alopecia areata is a common, tretinoin and hair loss, non-scarring, autoimmune disorder affecting any hair-bearing area. It is often psychologically devastating, tretinoin and hair loss. This disorder occurs in both the sexes, in all age groups, and is characterized by the sudden appearance of circumscribed areas of hair loss on the scalp or other parts of the body.
Although the etiopathogenesis of alopecia areata is still unknown, the most widely accepted hypothesis is that it is a T-cell mediated autoimmune condition that occurs in genetically predisposed individuals. Alopecia areata has a reported incidence of 0. The disease can begin at any age, but the peak incidence is between 20 and 50 years of age 5. Both the sexes are equally tretinoin and hair loss and there is no racial variation reportedClinically, alopecia areata may present tretinoin and hair loss a single well demarcated patch of hair loss, multiple patches, or extensive hair loss in the form of total loss of scalp hair alopecia totalis or loss of entire scalp and body hair alopecia universalis.
Histopathologically, alopecia areata is characterized by an increase in the number of catagen and telogen follicles and the presence of perifollicular lymphocytic infiltrate around the anagen phase hair follicles, tretinoin and hair loss. The condition is thought to be self-limited in majority of cases, but in some the disease has a progressive course and needs active treatment in the form of oral or topical therapeutic options.
Progressive alopecia areata is associated with severe social and emotional impact, tretinoin and hair loss. Alopecia areata mostly presents as a sudden loss of hair in well demarcated localized areas. The lesion is usually a round or oval flat patch of alopecia with normal skin colour and texture involving the scalp or any other region of the body.
The patch of alopecia may be isolated or there may be numerous patches. It usually has a distinctive border where normal hair demarcates the periphery of the lesion.
In acute phases, the lesions can be slightly erythematous and oedematous. The patches of alopecia areata are usually asymptomatic, although several patients may sometimes complain of local paraesthesia, pruritus or pain.
The affected hairs undergo an abrupt conversion from anagen to telogen, clinically seen as localized shedding. The hairs are tapered towards tretinoin and hair loss scalp end with thickening at the distal end. Although not absolutely pathognomonic, tretinoin and hair loss, it strongly suggests the diagnosis of alopecia areata.
Hair pull test conducted at the periphery of the lesion may be positively correlated six or more with disease activity. In the chronic phases, the test is negative, since the hair tretinoin and hair loss not plucked as easily as in the acute sensa weight loss and review. These are the hairs in which there occurs a fracture of the shaft inside the hair follicle, producing blackened points inside the follicular ostia resembling comedones.
In alopecia areata, the hair loss progresses in tretinoin and hair loss circumferential pattern. Often, distinct patches merge to form large patches.
Upon regrowth, hairs will often initially lack pigment resulting in blonde or white hairs 7. The prevalence of nail changes is greater in the more severe forms of alopecia areata such as alopecia universalis and alopecia totalisFinger nails are more commonly involved than the toe nails.
Pitting is the most common finding. Various ocular changes have been reported to occur in alopecia areata.
Treatment of alopecia areata is not mandatory in every affected patient because the condition is benign in majority and spontaneous remission is common. Treatment is mainly directed towards halting the disease activity taking viagra and xanax there is no evidence that the treatment modalities influence the ultimate natural course of the disease.
Addressing the impressive going to disney with animal allergy process occurring in alopecia areata, corticosteroids have by far been the most commonly used treatment modality Few treatments have been subjected to randomized control trials and except for contact immunotherapy, there is a paucity of published data on their long term outcomes.
Currently, new treatments targeting the immune system are being explored for the use in alopecia areata. Miscellaneous and Non-pharmacological treatment. Several topical corticosteroids with varying levels of efficacy have been used to treat alopecia areata. These include fluocinolone acetonide cream 17fluocinolone scalp gel, betamethasone valerate lotion 18tretinoin and hair loss, clobetasol propionate ointment 19dexamethasone in a penetration-enhancing vehicle and halcinonide cream They are a good option in children because of their painless application and wide safety margin Telangiectasia and local atrophy have also been reported.
Treatment must be continued for a minimum of 3 months before regrowth can be expected tretinoin and hair loss maintenance therapy often is sometimes necessary. Intralesional corticosteroids are widely used in the treatment of alopecia areata. The solution is injected in tretinoin and hair loss just beneath the dermis and a maximum of 3 ml on the scalp in one visit is recommended Lower concentrations of 2.
Regrowth usually is seen within weeks in responsive patients. Treatments are repeated every weeks. Skin atrophy at the sites of injection is a common side effect, particularly if triamcinolone is used, but this usually resolves after a few months. Repeated injections at the same site or the use of higher concentrations of triamcinolone should be avoided as this may lead to prolonged skin atrophyPain limits the practicality of this treatment method in children who are less than 10 years of age, tretinoin and hair loss.
Severe cases of alopecia areata, alopecia totalis, alopecia universalis as well as rapidly progressive alopecia areata respond poorly to this form of treatment Dithranol anthralin or other irritants have been used in the treatment of alopecia areata. The exact mechanism of action is unknown, but is believed to be through immunosuppressant and anti-inflammatory properties with the generation of free radicals. It wellbutrin xl and wellbutrin sr used at concentrations ranging from 0.
The applications are made initially every other day and later on daily. Adverse effects include pruritus, erythema, scaling, staining of treated skin and fabrics, folliculitis, and regional lymphadenopathy Minoxidil appears to be effective in the treatment of alopecia areata.
No more than 25 drops are applied twice per day regardless of the extent of the affected area. Initial regrowth can be seen within 3 months, but continued application is needed to achieve cosmetically acceptable regrowth. Minoxidil has also been studied in combination with anthralin 29topical betamethasone propionate 30 and prednisolone Minoxidil is of little benefit to patients of severe alopecia areata, alopecia totalis or alopecia universalisThe possible side effects from minoxidil are allergic and irritant contact dermatitis and hypertrichosis which is usually reversible with the interruption of the treatment.
Topical immunotherapy is the best documented treatment so far for severe and refractory cases of alopecia areata. Topical immunotherapy is defined as the induction and periodic elicitation of allergic contact dermatitis by applying a potent contact allergen Inthe alkylating agent triethyleneimino benzoquinone was the first topical sensitizer used to treat cutaneous disease, but it was abandoned on account of its mutagenic potential.
Later nitrogen mustard, poison ivy, nickel, formalin, and primin were tried, mainly as topical immunotherapy, tretinoin and hair loss, for alopecia areata and warts. Contact immunotherapy was introduced inby Rosenberge and Drake. DPCP is more stable in solution and is usually the agent of choice. Topical immunotherapy acts by varied mechanisms of action. The most important mechanism is a decrease in CD4 to CD8 lymphocyte ratio which changes from 4: A decrease in the intra-bulbar CD6 lymphocytes and Langerhan cells is also noted.
Expression of class I and III MHC molecules, which are normally increased in areas affected by alopecia areata disappear after topical immunotherapy treatment The protocol for contact immunotherapy was first described by Happle et al in The scalp is the usual sensitization site. Patients are advised to avoid washing the area and protect it from sunlight mechanism of action of antibacterial agents 48 hours.
After 2 weeks 0. The usual concentration of DPCP that ultimately causes mild contact eczema is 0. An eczematous response indicates that sensitization has taken place. It is important to remember that DPCP is degraded by light and should thus be stored in the dark and the patient should also wear a wig or hat during the day after application of DPCP. DPCP immunotherapy has even been combined with oral fexofenadine treatment with good effect The clinical response after wellbutrin and upset stomach months of treatment is rated as per the grading system proposed by Mcdonald Hull and Norris Grade 3- Regrowth of terminal hair with patches of alopecia.
If no regrowth is observed within six months of treatment, the patient is considered to be a non-responder. Other reported poor prognostic factors include the presence of nail changes, early onset disease and a positive family history Topical immunotherapy can lead to certain side effects such as persistent dermatitis, painfull cervical lymphadenopathy, generalized eczema, blistering, contact leukoderma, and urticarial reaction.
Systemic manifestations such as fever, arthralgia and yellowish discoloration of hair are noted more often with DNCB, tretinoin and hair loss. The method of application is the same as with DPCP but the applications are done once or twice weekly Good care should be taken to avoid contact with the allergen by handlers, including pharmacy and nursing staff.
Those applying the antigen should wear gloves and aprons. There is no available data on the safety of contact immunotherapy during pregnancy and it should not be used in pregnant women or in women intending to become pregnant. Yamamoto et al reported in their findings that tacrolimus stimulated hair growth in mice 41although subsequent studies have shown conflicting resultsRecently, Price et al reported an patient study in which none of the patients had terminal hair growth in response to tacrolimus ointment 0.
Garlic is a very commonly used home tretinoin and hair loss in the treatment of alopecia areata in India and even in the rest of the world. One study analyzed the effect of a combination of topical garlic gel and betamethasone valerate ointment in alopecia areata in a double-blind study. The study found the combination useful in majority of the patients with a statistically significant difference between the treatment and control groups Among topical retinoids, tretinoin and bexarotene have been tried in alopecia areata with mixed results Irritation of the skin is a very common side effect and the efficacy is doubtful in the absence of double-blind randomized trials.
The propensity of certain prostaglandin analogues used as anti-glaucoma eye drops to cause hypertrichosis has been employed in the treatment of alopecia areata.
These prostaglandin analogues include Latanoprost and Bimatoprost and they are used in the treatment of alopecia areata involving the eyelashes However, the results obtained with these drugs have not been really encouraging Systemic treatments, as a rule, are used only in progressive forms of alopecia areata and going by the immune nature of the disease, majority of these treatment options are immunosuppressants or immunomodulators in nature.
The use of systemic tretinoin and hair loss for the treatment of alopecia areata is under much debate. Some authors support a beneficial role of systemic steroids on halting the progression of alopecia areata, tretinoin and hair loss, but many others have had poor results with this form of therapy, tretinoin and hair loss.
The suggested dosages are 0. Treatment course ranges from months, but prolonged courses should be avoided to prevent the side effects of corticosteroids. Side effects profile of corticosteroids in conjunction with the long-term treatment requirements and high relapse tretinoin and hair loss make systemic corticosteroids a more limited option, tretinoin and hair loss.
In addition to the daily oral administration of corticosteroids, there are several reports of high-dose pulsed tretinoin and hair loss treatments employing different oral and intravenous regimens Many of these regimens have been tried in alopecia areata with encouraging results but the majority of these studies have been non-blind open studies. One such pulsed administration employs a high tretinoin and hair loss oral corticosteroid on two consecutive days every week with a gap of 5 days between the two pulses.