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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 1  |  Page : 35-37  

Concentric polycyclic regrowth pattern in alopecia areata


Department of Dermatology, Universidade Federal Fluminense, Niterói, Brasil

Date of Web Publication30-Mar-2016

Correspondence Address:
Lilian Mathias Delorenze
Rua Marquês de Paraná 303 - Niterói - RJ, 24033-900
Brasil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.179397

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   Abstract 

Alopecia areata (AA) is a common form of autoimmune nonscarring hair loss of scalp and/or body. Atypical hair regrowth in AA is considered a rare phenomenon. It includes atypical pattern of hair growth (sudden graying, perinevoid alopecia, Renbok phenomenon, castling phenomenon, and concentric or targetoid regrowth) and atypical dark color hair regrowth. We report a case of AA that resulted in a concentric targetoid hair regrowth and discuss the possible related theories regarding the significance of this phenomenon.

Keywords: Alopecia areata, corticosteroid treatment, hair disorder, hair regrowth


How to cite this article:
Delorenze LM, Gavazzoni-Dias MF, Teixeira MS, Aide MK. Concentric polycyclic regrowth pattern in alopecia areata. Int J Trichol 2016;8:35-7

How to cite this URL:
Delorenze LM, Gavazzoni-Dias MF, Teixeira MS, Aide MK. Concentric polycyclic regrowth pattern in alopecia areata. Int J Trichol [serial online] 2016 [cited 2019 Apr 19];8:35-7. Available from: http://www.ijtrichology.com/text.asp?2016/8/1/35/179397


   Introduction Top


ALopecia areata (AA) is a complex genetic, immune-mediated disease that targets anagen hair follicles [1] of the hair-bearing areas of the body.[2],[3] Atypical hair regrowth in AA is considered a rare phenomenon.[4]

We show a case of AA treated with intralesional corticosteroid with an unusual concentric targetoid hair regrowth pattern (THRP).


   Case Report Top


A 28-year-old male presented a 1-year history of hair loss in the beard and scalp. He was previously treated with intralesional corticosteroid. Examination revealed a single patch of alopecia on the scalp, with polycyclic aspect [Figure 1] consisting of central zone (A), intermediate zone (B), and peripheral zone (C). Zone A showed an area of thinning white hair, exclamation mark hair, and broken hair [Figure 2]a. The zone B showed healthy brown-colored hair [Figure 2]b. Zone C showed an area white hair, exclamation mark hair, and broken hair [Figure 2]c.
Figure 1: Zones A, B, and C

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Figure 2: (a) Dermoscopic features of zone A shows an exclamation mark hair (1) and broken hair (2); (b) Dermoscopic features of zone B without signs of activity of the alopecia areata; c) Dermoscopic features of zone C shows an exclamation mark hair (1) and broken hair (2)

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   Discussion Top


Hair recovery in AA usually occurs as a uniform process with thin white hair emergingfirst, followed by healthy hair. However, some authors have described atypical patterns of hair growth [Table 1].[4],[5],[6] THRP in AA wasfirst described by Orecchia and Rabbiosi in 1988.[7] El-Dars et al. also described a THRP in a patient with AA treated with topical corticosteroid gel.[8] Del Río described a patient treated with intradermal triamcinolone for AA and developed a THRP.[9] The THRP was also described by Tan and Delaney in eight patients as a possible result of the centrifugal accumulation of the corticosteroid cream.[10] Priego-Recio et al. described paradoxical hair regrowth forms in 1.84% of the patients and the most frequent forms were THRP (43%) and castling phenomenon (43%).[4] Ramot et al. reported atypical regrowth of black hair in two red-haired patients.[6]
Table 1: Atypical hair growing patterns and corresponding features

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A theory proposed in 1968 by Eckert et al. claims that AA occurs as an earthquake, beginning in an epicenter and expanding peripherally in a waveline manner. According to Eckert et al., an anagen/telogen wave enlarges from a core marginally expanding the alopecia.[11]

The theories of the anagen/telogen wave and the possible corticosteroid accumulation effect are not fully understood.[7],[8],[9]

Recently, Li and Sinclair measured the hairs plucked from the alopecia patch and discussed the anagen wave theory: Initially, a single hair in telogen is triggered to enter anagen and at the same time communicates with its immediate neighbor a signal for that hair to enter anagen. The initial regrowth signal is communicated to all the hairs within the patch of alopecia in a domino fashion.[12]


   Conclusions Top


Atypical hair regrowth in AA is considered a rare phenomenon but is possibly overlooked in the dermatologic literature.

Our patient presented the THRP, revealing the so-called anagen wave possibly due to a hair follicle signaling that allows follicles to communicate and follows a pattern of anagen growth, as suggested by Li and Sinclair.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Hordinsky MK. Overview of alopecia areata. J Investig Dermatol Symp Proc 2013;16:S13-5.  Back to cited text no. 1
    
2.
Bansal M, Manchanda K, Pandey S. Annular alopecia areata: Report of two cases. Int J Trichology 2013;5:91-3.  Back to cited text no. 2
    
3.
Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol 2000;42:549-66.  Back to cited text no. 3
    
4.
Priego-Recio CM, Rodríguez-Pichardo A, Camacho-Martínez FM. Unusual forms of alopecia areata in a Trichology Unit. J Eur Acad Dermatol Venereol 2014;28:1394-6.  Back to cited text no. 4
    
5.
Cicero RL, Micali G, Sapuppo A. Paradoxical hair regrowth during the treatment of severe alopecia areata with squaric acid dibutylester (SAD-BE). Eur J Dermatol 1993;3:321.  Back to cited text no. 5
    
6.
Ramot Y, Sinclair RD, Zlotogorski A. Regrowth of black hair in two red-haired alopecia areata patients. Australas J Dermatol 2012;53:e91-2.  Back to cited text no. 6
    
7.
Orecchia G, Rabbiosi G. Patterns of hair regrowth in alopecia areata. Dermatologica 1988;176:270-2.  Back to cited text no. 7
[PUBMED]    
8.
El-Dars LD, Kamath S, Logan R. Targetoid pattern of hair regrowth in alopecia areata: A case report. Clin Exp Dermatol 2009;34:413.  Back to cited text no. 8
[PUBMED]    
9.
Del Río E. Targetoid hair regrowth in alopecia areata: The wave theory. Arch Dermatol 1998;134:1042-3.  Back to cited text no. 9
    
10.
Tan RS, Delaney TJ. Letter: Circular regrowth in alopecia areata. Br J Dermatol 1975;92:233-4.  Back to cited text no. 10
[PUBMED]    
11.
Eckert J, Church RE, Ebling FJ. The pathogenesis of alopecia areata. Br J Dermatol 1968;80:203-10.  Back to cited text no. 11
[PUBMED]    
12.
Li J, Sinclair R. Clinical observations in alopecia areata: Implications and hypotheses. Australas J Dermatol 2016;57:e29-31.  Back to cited text no. 12
    


    Figures

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    Tables

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