Background Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients. Methods Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016. Results Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001). Conclusions Our study aimed to review epidemio‐clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early‐onset AA, long disease duration, and nail involvement were seen in our study.

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Nail lichen planus (NLP) affects 10% of patients with lichen planus (LP). 1 Isolated nail symptoms or twenty-nail dystrophy may occur. 2 It can have an aggressive course leading to a definitive destruction of the nail plate. Such disfigurement is aesthetically unacceptable and causes significant decrease in quality of life. Treatment of NLP is challenging, as there is a lack of guidelines. 3 Main options are corticosteroids and acitretin with usually disappointing outcomes and frequent F I G U R E 1 Effect of platelet-rich plasma injection for a nail lichen planus: (A) Preprocedural aspect: onychodystrophy in 68 year old related to lichen planus with a nail atrophy; the remaining nail is triangular with longitudinal ridges, splitting, thinning. The apparent nail bed is atrophic (B, C): HE Â10 (C): HE Â20 A biopsy from a fingernail bed showing an orthohyperkeratosis, Civatte bodies of the deeper parts of epidermis and a subepidermal lichenoid lymphocytic infiltration. (D): Result after the first session of PRP under the matrix with a significant improvement with regrowth a nail of a normal aspect and disappearance of the atrophy. (E, F) Pre and post procedural aspect after the first session in the thumb (G, H) Result after the second session (G) and the third session with significant improvement

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