Eyelash alopecia areata: Case series and literature review

Eye Center, University of California, Davis School of Medicine, Davis, Calif., USA.
Canadian Journal of Ophthalmology (Impact Factor: 1.33). 08/2012; 47(4):333-8. DOI: 10.1016/j.jcjo.2012.04.013
Source: PubMed


To characterize the clinical presentations, features, and outcomes of eyelash alopecia areata.
Retrospective chart review of patients evaluated for eyelash loss and found to have eyelash alopecia areata. A 3-year follow-up was required.
The study involved 15 patients.
Patients who presented at a tertiary care eye clinic for evaluation of eyelash loss and were found to have eyelash alopecia areata were reviewed. Demographic considerations were categorized; they included age at presentation, areas of other hair loss, other relevant history, and treatment responses.
Patients were young (mean age 18 years) and had a large female predominance (female-to-male ratio, 14:1). Concurrent scalp and brow involvement, either in isolation (20% and 13%, respectively) or together (13%), were seen in half of the patients (46%). Upper eyelid involvement was more common and severe than lower eyelid involvement, and 40% of patients experienced complete regrowth of lashes, with a mean time to regrowth of 28 months (range, 6 to 60 months). Of these, 13% experienced partial regrowth. Younger age at presentation was associated with regrowth, whereas presence or absence of other involved sites, personal or family histories of atopy, family history of alopecia, other autoimmune diseases, or the use of topical steroids did not appear to affect prognosis.
Eyelash alopecia areata is a unique entity, although it remains potentially underdiagnosed. The key differential diagnosis is trichotillomania, which is commonly associated with obsessive-compulsive disorders. The presence of exclamation-mark hairs in alopecia areata plays an important role in differentiating the 2 diagnoses.

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    • "The diagnosis of VZV-related permanent cicatricial hair loss is furthermore supported by the absence of eyelash hair regrowth after 3 months and the persistence of a slightly retracted, localized cutaneous atrophy at the site of a previous VZV lesion. The absence of other alopecic lesions, the cicatricial aspect of the eyelash, as well as the absence of hair regrowth and exclamation marks does not support a diagnosis of eyelash AA [13]. AA is one of the most frequent non-scarring cutaneous autoimmune diseases mediated by Th1 lymphocytes [14, 15]. "
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    ABSTRACT: Varicella zoster virus (VZV) cutaneous infection occurs predominantly in epidermal and infundibular keratinocytes and accessorily in dermal dendritic cells. These latter cells play a role in cicatricial processes. Two patients are presented with localized alopecia after VZV infection. A 4-year-old girl presented localized hair loss affecting about 20% of her upper right eyelash immediately following the resolution of the varicella skin lesions. No regrowth was observed after 3 months. An 80-year-old woman with a prior history of localized alopecia areata of the left occipital area presented severe left herpes zoster affecting the V1 and V2 dermatomes. At precisely the same site of the previous episode, a localized plaque of alopecia areata recurred. After topical corticosteroid therapy, a progressive hair regrowth occurred after about 3 months. These case reports are the first relating cutaneous VZV infection as the origin for permanent cicatricial alopecia and transitory alopecia areata. Localized hair loss should be added to the cutaneous complications of VZV skin infection.
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    ABSTRACT: Alopecia areata is understood as an autoimmune disease T cell-mediated mainly involving hair follicles in humans. It is a multifactorial aetiologic disease characterised by non-scarring alopecia and asymptomatic areas, affecting approximately 2 % of dermatology patients. Recent studies suggest that the pathogenesis of AA plays an important role in the association of certain HLA groups, neuroendocrine parameters and immunogenic factors. During 3 months (March to May 2013) at Hospital ClĂ­nic de Barcelona, 22 patients with severe alopecia areata underwent ophthalmic examination to determine whether there were ocular findings in the following parameters: Best-corrected visual acuity on decimal Snellen optotype, anterior segment slit-lamp examination and photograph, intraocular pressure measurement and dilated fundoscopy. Ultra-wide-field retinal imaging with or without red-free photograph was carried out with the Optomap 200 Tx (Optos, DunFermline, UK). Forty-four eyes of 22 patients were analysed [15 females (68.2 %)]. The mean age was 38.9 (SD 13.7) and mean time of evolution was 19.9 years (SD 16.3). Alopecia areata clinical patterns were multifocal [n = 10 (45.5 %)], universalis [n = 7 (31.8 %)], totalis [n = 3 (13.6 %)] and focal [n = 2 (9.1 %)]. Best-corrected visual acuity was 1.0 in almost all patients, but only three eyes (6.8 %) had vision of 0.7. Ocular findings were as follows: madarosis [n = 7 partial loss of eyelashes (31.85 %) and n = 4 total loss (18.2 %)], lens changes [n = 4 (18.2 %)], cataract [n = 3 (13.65 %)]. Ultra-wide fundus photography examination showed peripheral drusen [n = 17 eyes (38.6 %)], white-without-pressure changes [n = 8 eyes (18.22 %)] and peripheral retinal degenerations [n = 3 eyes (6.81 %)]. Ocular findings in patients with alopecia areata are reported and discussed by dermatologic and ophthalmic evaluation.
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