Alopecia areata: revisão e atualização

Abstract

Trata-se de artigo de revisão em que são analisados os aspectos clínicos, histopatológicos, etiopatogênicos e a terapêutica atual da alopecia areata. Enfatiza-se a posição nosológica atual da alopecia areata como doença auto-imune que se desenvolve em substrato genético e discutem-se os possíveis mecanismos fisiopatológicos da enfermidade, bem como os tratamentos atuais, particularmente para as formas mais graves da doença, compreendendo terapêuticas imunomoduladoras tópicas com dibutilester do ácido esquárico e difenciprona e seus possíveis mecanismos de ação.

Pistas dermatoscópicas para diferenciar a tricotilomania da alopecia areata em placa

“…5 The hair pull test is a useful semiotic element, which, if negative, favors a diagnosis of trichotilloma- 5 In AA, it is positive, particularly along the edges of patches in activity. 9 In cases of AA, dermoscopic findings include clusters of short vellus hairs (shorter than 10 mm), as well as yellow dots and dystrophic hair (black dots or cadaverized hair) and exclamation mark hair. 2,3 Ross et al were the first to observe yellow dots in a patient with trichotillomania; however, biopsy revealed AA in the same patch.…”

“…Examination of the patient's nails may reveal pitting (Table 1). 9 In cases of trichotillomania, dermoscopy reveals abnormalities resulting from the stretching and fracture of hair shafts. Fracture may occur at varying lengths, resulting in black dots, hair broken off, either close to the hair follicles or at different distances from them, fraying hair, longitudinally split hair, coiled hair and stretching of the shaft.…”

A importância do exame tricológico no diagnóstico da alopecia areata

“…1.2 The disorder most frequently affects the scalp, but can also occur in other areas such as the eyebrows, eyelashes, beard and pubic hair. 2 AA is clinically classified in a number of different forms according to the quantity, extent and topography of lesions. The classic forms include: AA in plaques; ophiasic AA (pattern of hair loss affecting the frontoparietal, temporal and occipital regions); total AA (total loss of terminal hair of the scalp without involvement of other body hair); and 'AA universalis', spreading to the entire epidermis.…”

“…The atypical forms are: Sisaifo-type alopecia areata (inverse ophiasis), reticular AA and diffuse AA. [1][2][3] The diagnosis of AA involves studying the patient´s case history, conducting a clinical examination and trichological workup. AA contains numerous propedeutic signs, thus a careful trichological examination is essential for diagnosis.…”

“…The plaques are usually asymptomatic, although slight pruritus or a local burning sensation can occur. 1,2,5 The hairs detach easily by gentle traction on the periphery of plaques (gentle traction sign). 1,2,5,6 Note however that this sign is not specific to the acute phase of plaque AA and can occur in the diffuse forms of AA, as well as in the initial telogen effluvium.…”