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Alopecia areata

Alopecia areata (AA) is manifested by non-scarring focal hair loss and is classified as an autoimmune disease. The prevalence of this disease in the general population is 1-2%. Alopecia areata is responsible for up to 3% of patients seen by dermatologists. In 50% of patients, the disease starts in adolescence. A typical symptom is a presence of well-delimited hairless areas. The pathological mechanism leading to alopecia areata is not completely understood. The influence of genetic factors and environmental factors (including stress) is often emphasized as a trigger of the autoimmune process.

Symptoms
In patients, a sudden appearance of a round or oval denuded patch is observed. The number and size of patches may differ; sometimes it is one patch 1-2 cm in diameter, less frequent there are numerous, often merging bald patches. There are several forms of alopecia areata: focal alopecia, diffuse alopecia areata, ophiasis (balding in the occipital and temporal areas), alopecia totalis (hair loss of the scalp), and alopecia universalis (total body hair loss).

Course of disease
The course of the disease is hard to predict. Worse prognoses are observed in patients with an early onset of the disease, with a family history of alopecia areata, accompanying atopy, and in case of coexistence of other autoimmune diseases or nail lesions. It seems that the most important prognostic factor is the extent of the hair loss. In some patients, spontaneous remissions are observed, while in approximately 5% of patients, a progression towards total alopecia totalis is noticed, and in 1%, progression towards alopecia universalis detected. Sometimes, recurrent course of the disease is observed.

Diagnosis
The diagnosis is determined based on the clinical picture and trichoscopy.

Treatment
Topical administration drugs and general administration drugs are used. Immunosuppresive drugs (corticosteroids, cyclosporin), photochemotherapy (PUVA), and immunomodulation drugs are used. In some cases, psychological care is also needed.