A 32 Year Old Man Presents With Hair Loss

A 32 year old man who is otherwise healthy presents with patchy hair loss from the scalp that he observed a few months ago. He denies any recent change in his shampoo or use of any chemicals. He denies any recent illness or use of drugs. He is concerned about the hair loss and the patches of hair loss are progressively increasing to involve more areas of his scalp.
The picture of the patient is shown below:

What is the Diagnosis?
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 Alopecia Areata.

Case Discussion:
Alopecia means hair loss and Alopecia areata is a medical condition in which hair loss occurs in some or all areas of the body in patches. It is an autoimmune disorder and it is most commoly seen on the scalp but may involve the whole body.

Patients are otherwise healthy, the condition is not contagious and there is no nerve involvement.
Since it causes bald spots on the scalp usually in the early stages it is also sometimes called as spot baldness.

Types: It has different types depending on the type and extent of hair loss.


1. Diffuse Alopecia areata: when hair loss is diffuse involving the scalp and the whole body.
2. Alopecia areata monolocularis: when there is hair loss in one spot anywhere on the scalp.
3. Alopecia areata multilocularis: when hair loss involves multiple areas.
4. Ophiasis: hair loss in a shape of a wave at the circumference of the head.
5. Alopecia areata barbae: when hair loss is limited to the beard area.
6. Alopecia totalis: when all the hair of the scalp are lost.
7. Alopecia universalis; when all the body hair including the pubic hair are lost.

Treatment: In most of the cases the condition is self limited and only observation is needed. It is a benign condition with spontaneous remission and recurrences. It may cause significant emotional and psychological stress to the patients.

1. Topical corticosteroid therapy is sometimes helpful in preventing the progression.
2. Minoxidil is effective and is used in patients with extensive hair loss.
3. Cosmetic management may be helpful for some patients.