Pelade ( Alopecia Areata)

Pelade is an autoimmune disease in which the body’s immune system mistakenly attacks hair follicles, leading to localized bald patches on the scalp, beard, eyebrows, or other hair-bearing areas.

Causes of Pelade:

1. Autoimmune Reaction

The immune system mistakenly attacks healthy hair follicles, treating them as foreign.
This stops hair growth temporarily, causing bald patches.

2. Genetic Factors

Family history increases the risk.
About 10–20% of patients have relatives with alopecia areata or other autoimmune diseases.

3. Other Autoimmune Conditions

People with pelade are more likely to have or develop:

Thyroid disease (Hashimoto, Graves)
Vitiligo
Type 1 diabetes
Rheumatoid arthritis

4. Environmental Triggers

Stress (physical or emotional)
Viral or bacterial infections
Hormonal changes

5. Genetic & Immune System Interaction

Certain genes (HLA types) increase susceptibility.
Triggering factors (like stress or infection) can activate the immune attack in genetically predisposed people.

symptoms of Pelade:

1. Hair Loss (most common sign)

Sudden appearance of round or oval bald patches on the scalp, beard, eyebrows, eyelashes, or other body areas.
The skin in bald patches looks smooth, normal, and not scarred.

2. Exclamation Mark Hairs

Short broken hairs that are narrower at the base (like an exclamation mark), often seen at the edge of bald patches.

3. Changes in Nails (in some patients)

Tiny pits (small depressions) on the nail surface.
Ridges or roughness of nails.
Nails may become thin, brittle, or split.

4. Pattern of Hair Loss

May stay limited to small patches.
Can progress to:
- Alopecia totalis → complete scalp hair loss.
- Alopecia universalis → loss of all body hair.

5. Other Features

Usually no itching or pain.
Sometimes mild tingling or burning sensation before hair falls.

Treatment for Pelade ( Alopecia Areata):

1. Topical Treatments (applied on skin)

Corticosteroid creams or ointments → reduce immune attack on hair follicles.
Minoxidil (Rogaine®) → stimulates hair growth.
Topical immunotherapy (DPCP, SADBE) → creates mild allergic reaction to distract immune system from attacking follicles.
Anthralin cream → alters immune activity in the skin.

2. Injections

Corticosteroid injections directly into bald patches (common for small areas).
Helps hair regrow within weeks to months.

3. Oral Medications (for severe cases)

Corticosteroid tablets → short-term use (risk of side effects).
Immunosuppressants: methotrexate, cyclosporine, azathioprine.
JAK inhibitors (new treatments): tofacitinib, baricitinib, ruxolitinib → promising results in resistant cases.

4. Light Therapy (Phototherapy)

UV light treatment (PUVA) sometimes used.

5. Supportive Measures

Wigs, hairpieces, scarves for cosmetic cover.
Psychological support (stress management, counseling).
Balanced diet, reducing stress, treating underlying autoimmune disease.