| • | exclamation point hairs (when present are diagnostic) |
| • | these short broken hairs, whose distal ends are broader than the proximal ends, illustrate their inherent sequence of events, i.e. follicular damage in anagen and then a rapid transformation to telogen |
| • | white or graying hairs are frequently spared and probably account, in cases of fulminant alopecia areata, for the mysterious phenomenon of “going gray overnight” |
| • | thought to be autoimmune (SLE, atopy, thyroid disease, vitiligo are more common in AA patients) |
| • | check eyebrows and eyelashes to help support diagnosis when there is a differential |
| • | also check nails for grid-like pitting |
| • | the tendency is for spontaneous recovery in patients who are post-pubertal at onset (~ 3 months to 2 years) |
| • | poor prognostic features: childhood onset; duration > 5years; ophiasis pattern; widespread involvement |
histology:
| • | increased numbers of catagen and telogen hairs with infiltrates of mononuclear cells in and around hair bulbs |
treatment:
| • | pearl (for eyebrow or small spot on face) - bimatoprost ophthalmic solution (7.5ml is largest size) |
| • | pearl - allegra 180QD (or child dose for kids) |
|