Alopecia Areata: How active is it?

How active is it?

Alopecia areata is an autoimmune condition that affects up to 1.7 % of the world’s population.  In the early stages (called ‘acute’ alopecia areata), inflammation is present in the skin at the bottom of hair follicles that inflammation causes these hair follicles to be lost.

There are many “trichoscopic” (dermatoscopic) features of alopecia areata, including broken hairs, yellow dots, black dots, exclamation mark hairs, tapered hairs. 
In the early stages of alopecia areata, one can often gather a great deal of information about a patient’s chance of regrowth over the next few months by careful examination of the scalp.

Consider the patient with a patch of hair loss shown in the photo. Numerous white hairs are present in color indicating that a large proportion of the hairs are trying their best to grow. The hairs are white because the immune system has affected the pigment producing cells in the hair follicles making it difficult for them to add pigment into the follicle. (The hair first tries to remember how to make a hair fiber and then tries to remember how to add pigment to it). The yellow arrow shows an exclamation mark hair indicative of active disease.

The green arrow in the photo points to small regions of the white hairs that do in fact contain pigment. This is a nice reminder to me that these particular hairs are not too far off from producing thicker, longer, and fully pigmented hairs. In this particular patient, the chances of hair growth with steroid injections was estimated at well above 80 %... and fortunately the patient returned back to clinic with marked growth.

Alopecia areata is an autoimmune condition that affects up to 1.7 % of the world’s population.  In the early stages (called ‘acute’ alopecia areata), inflammation is present in the skin at the bottom of hair follicles that inflammation causes these hair follicles to be lost.

There are many “trichoscopic” (dermatoscopic) features of alopecia areata, including broken hairs, yellow dots, black dots, exclamation mark hairs, tapered hairs. 
In the early stages of alopecia areata, one can often gather a great deal of information about a patient’s chance of regrowth over the next few months by careful examination of the scalp.

Consider the patient with a patch of hair loss shown in the photo. Numerous white hairs are present in color indicating that a large proportion of the hairs are trying their best to grow. The hairs are white because the immune system has affected the pigment producing cells in the hair follicles making it difficult for them to add pigment into the follicle. (The hair first tries to remember how to make a hair fiber and then tries to remember how to add pigment to it). The yellow arrow shows an exclamation mark hair indicative of active disease.

The green arrow in the photo points to small regions of the white hairs that do in fact contain pigment. This is a nice reminder to me that these particular hairs are not too far off from producing thicker, longer, and fully pigmented hairs. In this particular patient, the chances of hair growth with steroid injections was estimated at well above 80 %... and fortunately the patient returned back to clinic with marked growth.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887



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