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| CASE REPORT |
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| Year : 2016 | Volume
: 8
| Issue : 1 | Page : 35-37 |
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Concentric polycyclic regrowth pattern in alopecia areata
Lilian Mathias Delorenze, Maria Fernanada Reis Gavazzoni-Dias, Marcelo S Teixeira, Marcia Kalil Aide
Department of Dermatology, Universidade Federal Fluminense, Niterói, Brasil
| Date of Web Publication | 30-Mar-2016 |
Correspondence Address:
Lilian Mathias Delorenze
Rua Marquês de Paraná 303 - Niterói - RJ, 24033-900
Brasil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-7753.179397
 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 |
| Introduction | |  |
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 | | |
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 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 | | |
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]
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 | | |
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 | | |
| 1. | Hordinsky MK. Overview of alopecia areata. J Investig Dermatol Symp Proc 2013;16:S13-5.  |
| 2. | Bansal M, Manchanda K, Pandey S. Annular alopecia areata: Report of two cases. Int J Trichology 2013;5:91-3. |
| 3. | Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol 2000;42:549-66. |
| 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. |
| 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. |
| 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. |
| 7. | Orecchia G, Rabbiosi G. Patterns of hair regrowth in alopecia areata. Dermatologica 1988;176:270-2. [ 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. [ PUBMED] |
| 9. | Del Río E. Targetoid hair regrowth in alopecia areata: The wave theory. Arch Dermatol 1998;134:1042-3. |
| 10. | Tan RS, Delaney TJ. Letter: Circular regrowth in alopecia areata. Br J Dermatol 1975;92:233-4. [ PUBMED] |
| 11. | Eckert J, Church RE, Ebling FJ. The pathogenesis of alopecia areata. Br J Dermatol 1968;80:203-10. [ PUBMED] |
| 12. | Li J, Sinclair R. Clinical observations in alopecia areata: Implications and hypotheses. Australas J Dermatol 2016;57:e29-31. |
[Figure 1], [Figure 2]
[Table 1]
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