Acute diffuse and total alopecia: A new subtype of alopecia areata with a favorable prognosis.

A biopsy and hair root examination should be performed in cases of sudden-onset diffuse alopecia

June 2010

Commentary from Faculty Member Arnold Oranje Erasmus MC Sophia Children's Hospital, Netherlands, Dermatology

This article is interesting because of the illustration that acute diffuse hair loss may indicate alopecia areata (AA). It also explains why somebody may become grey in one night, although this is not mentioned by the authors. It is also fascinating to me that acute diffuse hair loss has a good prognosis, while other subtypes of AA have a bad prognosis. So, the type of AA tells you something about the prognosis.

The authors presented a series of patients, women in 85% of the cases, aged older than 20 years with acute diffuse alopecia diagnosed as a form of AA. They called the disorder acute diffuse and total alopecia (ADTA).

Over a time span of five years they observed 30 such cases, surprisingly the majority were women. This study is an observational case-history series.

Thirty patients, over a 5-year period, were diagnosed with ADTA and then followed up. The diagnosis is based on clinical presentation and histological examination.

However, biopsies were only taken from 18 of the 30 cases. Hair root examination was not performed, instead of this, the authors performed hair-pull tests at different bilateral points.

The lack of hair root examination and also the lack of histology in 12 of the 30 cases are major weaknesses of this study.

Another maybe even more striking point is that there was no investigation into stress factors. I have seen only incidental cases with this clinical presentation of AA. I consider this subtype of AA to be one of the reasons why somebody goes bald or grey in one night. Usually stress factors were involved.

Abstract

BACKGROUND:

Alopecia areata (AA) appears in several clinical forms, all having different clinical courses and different prognoses. Acute diffuse and total alopecia (ADTA) has been reported to have a short clinical course ranging from acute hair loss to total baldness, followed by rapid recovery.

OBJECTIVE:

To determine the clinical course and prognosis of ADTA through precise clinical observations.

METHODS:

Thirty Korean patients who showed ADTA of the scalp within an average of 10 weeks after the onset of hair loss were studied.

RESULTS:

Most patients were women who were older than 20 years of age. The histopathology of the lesion revealed infiltration of mononuclear cells around the hair follicles and prominent pigment incontinence. The patients experienced hair regrowth within about 6 months, without regard to the method of treatment.

LIMITATIONS:

The duration of follow-up after remission ranged from 3 to 49 months, with a mean of 24 months.

CONCLUSIONS:

These cases can be categorized as having "acute diffuse and total alopecia," a new subtype of AA that is associated with a favorable prognosis and rapid and spontaneous recovery even without treatment.

Source