The most characteristic feature of alopecia areata is having a clear marked patch of hair-loss in the scalp. It is mostly a round/oval smooth patch surrounded by areas with normal hair growth. Sometimes thin white hair grows in the bald patch/patches after a few months. Patients feel distressed and upset to see clumps of hair falling off in the shower or on the pillow and sudden visible bald patches on the scalp.
When you see suddenly a patch of bald scalp, you may feel panicky and go to the doctor. A physical examination will be conducted and the doctor will ask about your medical history. He will look at the pattern of hair loss, and conduct a scalp examination. If the area infected looks expanding, the doctor will pull out some hair for hair analysis. He may check for the presence of yellow-color skin deposit around hair follicles, fractured short hairs. He will check your nails.
To confirm the diagnosis of alopecia areata, he will do
- Hair analysis – look at your hair sample under microscope.
- Biopsy – A small skin sample is taken from the scalp and a biopsy is done (optional).
- Blood tests – Are ordered only if the dermatologist suspects the presence of other coexistent autoimmune disease like an overactive/underactive thyroid gland.
Elimination of other hair-loss causes
The doctor will rule out other diseases causing hair loss and may be mistaken for alopecia areata such as
- Telogen effluvium – Hair loss from certain drugs, high fever, intense stress and pregnancy.
- Androgenic alopecia – Known as male-pattern baldness.
- Trichotillomania – A psychic condition where the patient manually pulls the hair out.
- Secondary syphilis – Where moth-eaten type baldness all over the scalp is present.
Dermoscopy is a recent pioneering procedure to evaluate hair loss. Its role in alopecia diagnosis is still in the initial stages. It is a simple and safe method to identify specific features that occur in alopecia areata only like – tapering hairs, cluster of short hairs, broken hairs, and some black dots. Most importantly, it confirms the presence of yellow color matter that cluster at hair follicles specific only to alopecia areata and not found in other alopecia conditions.
Mostly the fallen hair re-grows by itself, and treatment can speed up the growth. Appropriate counseling is essential for the distressing and damaging psychological impact. Camouflaging with suitable cosmetics until hair re-grows can hide the bald patches.
- American Academy of Dermatology – Alopecia Areata: Signs and Symptoms view
- MedicineNet – About Alopecia view
- Patient.co.uk (Original Author: Dr Tim Kenny) view
- National Institue of Health – Questions and Answers about Alopecia Areata view
- Dermatology – About.com (Heather Brannon, MD) view
- Medscape – Drugs, Diseases and Procedures [Alopecia Areata – Author: Chantal Bolduc, MD, FRCP(C); Chief Editor: Dirk M Elston, MD] view