الفهرس 
Alopecia AreataOnly 14 pages are availabe for public view
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Abstract
Alopecia areata is a chronic inflammatory disease which affects the hair follicles and sometimes the nails. The onset may be at any age and there is no known race or sex preponderance. Alopecia areata usually presents as patches of hair loss on the scalp but any hair-bearing skin can be involved. The affected skin may be slightly reddened but otherwise appears normal. Short broken hairs (exclamation mark hairs) are frequently seen around the margins of expanding patches of alopecia areata.
Alopecia areata is easily distinguishable from telogen effluvium, androgenetic alopecia, and tinea capitis.
About 20% of people with alopecia areata have a family history of the disease, indicating a genetic predisposition. Associations have been reported with a variety of genes, including major histocompatibility complex, cytokine and immunoglobulin genes, suggesting that the genetic predisposition is multifactorial in nature. The hair follicle lesion is probably mediated by T lymphocytes. The autoantigen in alopecia areata remains to be identified, but results from current studies suggest that it may be derived from melanocytes. The association between alopecia areata and other autoimmune diseases suggests that alopecia areata is itself an autoimmune disease.
An overriding consideration in the management of alopecia areata is that, although the disease may have a serious psychological effect, it has no direct impact on general health that justifies the use of hazardous treatments, particularly of unproven efficacy. In addition, many patients, although by no means all, experience spontaneous regrowth of hair.
A number of treatments can induce hair growth in alopecia areata but none has been shown to alter the course of the disease. The high rate of spontaneous remission makes it difficult to assess efficacy, particularly in mild forms of the disease. Some trials have been limited to patients with severe alopecia areata where spontaneous remission is unlikely. However, these patients tend to be resistant to all forms of treatment and the failure of a treatment in this setting does not exclude efficacy in mild alopecia areata.
Leaving alopecia areata untreated is a legitimate option for many patients. Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (< 1 year) although the remission rate in patients reaching secondary care is lower. Many patients may therefore be managed by reassurance alone, with advice that regrowth cannot be expected within 3 months of the development of any individual patch.
The treatment of AA depends on the severity and extent of the disease. The medications include a topical irritant, topical, intralesional steroids, topical minoxidil, topical cyclosporine and topical tacrolimus. More aggressive therapy is used for severe cases, such as systemic corticosteroids, immunosuppressive drugs, and immune modulators.
One of the therapeutic agents for alopecia areata is topical sensitization e.g[squaric acid dibutylester (SADBE) and diphencyprone (DPCP)]. By altering the pathogenic inflammatory response with few side effects, sensitizers offer an attractive treatment option for many patients with alopecia areata.
Anthralin was used topically in some studies for patchy alopecia areata. Topical garlic gel significantly added to the therapeutic efficacy of topical betamethasone valerate in alopecia areata.
Five fluorouracil occasionally induces an allergic contact dermatitis, but more typically produces a brisk irritant dermatitis. Its irritant properties may be enhanced by factors that increase the permeability of the skin to which it is applied.
Different types of laser like 308-nm excimer laser, pulsed infrared diode laser and fractional erbium glass laser were used in treatment of alopecia areata in many studies.
Topical 5FU cream application after ER:YAG laser ablation till erythema for one session have been used in treating periungual vitiligo with good results, in our study we depended on that many therapies like topical steroids, systemic steroids, PUVA and excimer laser can treat both vitiligo and alopecia areata. We collected 15 male patients each of them had at least three patches alopecia areata. We treated one patch (ER+5FU patch) with ER: YAG laser till erythema for one session then we daily applied 5FU cream till irritation (redness, oozing and scaling) which occurred in most patients before the third application, the second patch (ER patch) treated only by ER: YAG laser till erythema for one session. The residual patch had no treatment and served as the control patch.
After two months of therapy we found that ER: YAG laser ablation till erythema for one session is not effective in treatment of alopecia areata as only 33.3% of treated patches showed good improvement versus 46.7% of the control patches and 66.7% of ER+5FU patches.
We found that 66.7% of ER+5FU patches showed good improvement versus 46.7% of the control patches, although there was not a significant difference between both group we expect different result if we increase the days of cream application or the degree of laser ablation before 5FU cream application.