Alopecia areata may occur as either a mild, chronic, patchy condition or as a severe, generalized hair loss. Certain risk factors can help identify patients who may develop the more severe forms.
Severe forms of alopecia areata:
(1) alopecia totalis
(2) alopecia universalis
Risk factors for severe alopecia areata:
(1) young age of onset (Sharma et al use < 20 years of age)
(2) family history of vitilgo
(3) presence of nail changes (see below)
A person with all 3 findings has a high risk for severe alopecia areata.
Nail changes (Sharma et al):
(1) pitting
(2) longitudinal ridging
(3) trachyonychia (rough nail)
(4) stippled leukonychia
(5) yellow, brown discoloration
(6) pigmented bands
(7) shiny nails
(8) lusterless nails
(9) distal fraying
(10) terminal V-shaped nicks
(11) oncholysis
(12) platynychia
(13) koilonychia
(14) racket-shaped nail
(15) splinter hemorrhages
(16) Beau's line
(17) fissured eponychium
(18) paronychia
(19) suffused nails
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