CHILDHOOD ALOPECIA AREATA - CASE REPORT

- Alopecia areata (AA) is a immuno-mediated cronic disorder, characterized by the interruption of the hair cycle, targeting anagen hair follicles and causing non-scarring hair loss. The most commonly affected area is the scalp. It targets 1 in 1000 peoples with onset usually under 30 yo. AA is associated with other immune-mediated disorders such as vitiligo and thyroiditis. Recurrence is real possibility and childhood onset and duration longer than a year are both worst prognosis factors. Generally, examination makes the diagnosis: discrete and smooth alopecia patches, “exclamation mark” hairs limiting the patch and occasional red skin. The “hair pull test” is positive in patients with active alopecia. The differential diagnosis must include tinea capitis, trichotillomania, cicatricial alopecia, androgenic alopecia, secondary sifilis, telogen effluvium and triangular alopecia. - UpToDate and Pubmed search with MeSH Alopecia. Case report: 3 yo male. He presented with alopecia patches on the scalp, smooth skin, exclamation mark hairs on the edges of the patches, without any inflammatory signs. His mother had Vitiligo and was going through marital problems. He underwent treatment with topical and systemic glucocorticoids and Minoxidil5%. Blood tests were all normal. He is having a positive but slow evolution. - This is a case of Childhood AA with bad prognosis factors where the only identified trigger factor was emotional distress and a familiar positive history of Vitiligo. Psicologic support must be offered. The possible therapeutic next step includes intra-lesional corticosteroid, topical immunotherapy, anthralin and stopping the systemic corticoids because of their serious side effects.