Alopecia Areata in a 32-Year-Old Man

Round, smooth, bald areas had recently developed on the neck and chin of a 32-year-old man. No other areas of the body were affected. The patient had a lifelong history of chronic anxiety. Dr Robert P. Blereau of Morgan City, La, diagnosed alopecia areata of the beard, an area that is affected less often than the scalp. This disease usually occurs suddenly in persons younger than 40 years and may be at single or multiple sites. Typically, the skin is smooth or features poorly defined hair shafts that break easily at the skin surface. Microscopic examination of the hair demonstrates a normal upper shaft with a narrowed base and a lymphocytic perifollicular infiltrate. Regrowth often begins within several months; however, the condition can recur in the same or other locations. Patients with limited involvement have an excellent prognosis. The cause of alopecia areata is unknown. Although anxiety is frequently associated with the disorder and has been thought by some to be causative, at least one study found that stress has no significant role.¹ Associations between alopecia and thyroid disease, pernicious anemia, Addison disease, vitiligo, lupus erythematosus, ulcerative colitis, and Down syndrome have been noted.² Treatment is not necessary if the prognosis for regrowth is good. In recalcitrant cases, intralesional corticosteroid injections can stimulate regrowth but may cause atrophy, and hair loss may recur. Other therapies that have shown some success include pulsed intravenous and oral corticosteroids, topical allergens, anthralin, minoxidil, oral or topical cyclosporine, nitrogen mustard, psoralen-UV-A therapy, and inosiplex. Paroxetine was prescribed to treat this patient's anxiety; however, he did not return for follow-up.