DISCUSSION
The predisposing factor is atopy, young age, and large areas of peripheral scalp involvement, termed ophiasis. All the other choices have little or no effect on the outcome.
Alopecia areata is known to be an autoimmune condition in which antibodies are produced that prevent new hair growth. No prevalence has been observed in specific ethnic races. Treatment can cause hair to temporarily regrow, but does not influence longterm outcome. By definition, all patients with all forms of alopecia demonstrate a lack of epidermal changes in their scalp lesions; that is, no changes, such as redness, edema, scaling, eschar, or scarring, are seen on the surface of the overlying skin. If the condition progresses on this continuum, however, the end result is total and permanent loss of every hair from every part of the body (alopecia universalis) for a tiny percentage of patients with alopecia areata. However, atopy, youth, and ophiasis appear to be predictors of a poor outcome.
Prevalence of alopecia areata in the general population is estimated at 0.1% to 0.2%, with a lifetime risk of about 1.7% for any given individual. Persons with alopecia areata appear to have a genetic predisposition to developing the condition. A definite increase in the incidence of other autoimmune diseases is seen in these same patients and in their relatives.
Treatment Many different treatments have been tried, with varying degrees of success. These treatments include topical, intralesional, and systemic corticosteroids; calcineurin inhibitors; immunotherapy with dinitrochlorobenzene or squaric acid; anthralin, and many others. As in this patient, localized, short-term hair growth can be seen. Given the patient's lack of response to all treatment options, the presence of all three negative-prognostic factors listed above, and the duration and progression of his disease, this patient's prognosis would appear to be poor. JAAPA
Joe Monroe works at the Regional Dermatology Clinic, Bartlesville, Oklahoma, and is the department editor for Dermatology Digest. He has indicated no relationships to disclose relating to the content of this article