Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
How I Manage
2001:67:4;188-188
PMID: 17664736

Alopecia areata

DM Thappa, M Vijayikumar
 Department of Dermatology and STD, JIPMER, Pondicherry - 605006, India

Correspondence Address:
D M Thappa
Department of Dermatology and STD, JIPMER, Pondicherry - 605006
India
How to cite this article:
Thappa D M, Vijayikumar M. Alopecia areata. Indian J Dermatol Venereol Leprol 2001;67:188
Copyright: (C)2001 Indian Journal of Dermatology, Venereology, and Leprology

It is said that the only predictable thing about the progress of alopecia areata (AA) is the it is unpredictable. The first thing we tell our patient of AA is that hair regrowth may occur in about one third of the patients without any treatment. However, most of the patients are anxious, have undergone severe emotional stress, are well-motivated by the given treatment. We divide patients according to agethose less than 10 years and those of 10 years of age or more. The patients older than 10 years are further divided based on the extent and progression of hair loss those with less than 30% scalp surface area involved and those with more than 30% involvement or rapidly progressive hair loss of less than 1-year duration.

1. Patients with less than 10 years of age: We use non-specific topical irritants like tincture iodine or non- specific immunomodulators like anthralin as the first line of management. Patients are asked to apply tincture iodine on areas of hair loss overnight to elicit irritant reaction. If no regrowth occurs after 2 months of therapy, short-contact anthralin therapy is tried. Compound dithranol ointment (Derobin ointment-dithranol 1.15%, salicylic acid 1.15% and coal tar 5.3%) is applied on the leg for 30 minutes to 1 hour. If the patient is able to tolerate the drug, then application on the scalp is recommended. Usually response occurs after 2 to 3 months. We use topical corticosteroid lotion or cream (for example fluocinolone acetonide 0.05%) as second line therapy. They are applied overnight on alternate days or on five days a week to prevent atrophy of the skin. Response is expected after 6 to 8 weeks.

2. Patients older than 10 years: < 30% scalp surface involved: Short contact anthralin or topical corticosteroids are tried first. If hair regrowth does not occur after 2 to 3 months, then intralesional corticosteroids are recommended. Triamcinolone acetonide 10 mg/ml diluted with equal amount of 1% xylocaine solution can be used. It is administered as multiple intradermal injections of 0.1 ml per site, about 1cm apart using a 30-gauge needle fitted to an insulin syringe. Injections are repeated every 4 weeks. Usually patients respond by 4 to 8 weeks. If patients do not show response even after 6 months of intralesional corticosteroids, therapy is discontinued as they may lack adequate corticosteroid receptors in the scalp.

3. Patients older than 10 years, > 30% scalp involved or rapid progressive alopecia< 1-year duration: We use dexamethasone pulse therapy as the main line of treatment. It consists of 32 mg of dexamethasone in 200 ml of 5% dextrose given intravenously on three consecutive days (total 96 mg) every 4 weeks. Cosmetically acceptable results have been observed in 66% of cases of extensive alopecia areata and alopecia totalis. Arrest of progression of hair loss occurs after 2 to 3 pulses. If patient shows no response by 6 pulses, treatment is discontinued. In patients showing response, treatment is continued for up to 10 pulses. If patient is unwilling for intravenous pulse therapy, oral minipulse with 5 mg betamethasone tablets given twice weekly for up to 6 months. In our experience intravenous dexamethasone pulse therapy appears to be more effective than oral betamethasone pulses. Patients with alopecia universalis, those having progressive hair loss for more than 2 years and patients not responding to treatment are encouraged to use a wig or cap as cosmetic camouflage.


Fulltext Views
76

PDF downloads
18
Show Sections