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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