ARTICLE
In a follow-up study performed on 1,604 cases of alopecia areata (AA)
seen in the Trichology Unit of our Department of Medical-Surgical Dermatology
from 1975-1993, we described a new form of presentation of alopecia areata
that we named "sisaipho" [1] although other authors prefer to name it
"ophiasis inversus" [2]. It is the loss of all of the scalp hair except
for a rare band of hair in the fronto-parieto-temporal scalp [3]. In another
paper, we described a new pattern of hair regrowth in AA that we termed
androgenetic alopecia (AGA) type with male (MAGA) or female pattern (FAGA)
[4].
The objective of this study was to describe the association of two atypical
presentation forms of AA, and to study the clinical forms in a 4 year
period.
Material and methods
From 1993 to 1996, 356 new patients with AA attended our Trichology
Unit. All of them were studied and classified according to their clinical
form.
Results
The patients presented the alopecia areata type shown in Table
I.
It is necessary to comment that the last patient of the table was a
16-year-old boy who developed an AA type MAGA with Hamilton's score IV
(Fig. 1a, b). In 6 months
he lost his frontal hair line, presenting the aspect of an AA type male
androgenetic alopecia, Hamilton's grade VIII, the hair in the occipital
area remained as a sisaipho or ophiasis inversus (Figs.
2a, 2b). He was treated with topical and intralesional corticosteroids
plus minoxidil 5% solution without improvement.
CONCLUSION
We would like to highlight two points of interest. Firstly, the proportion
of the different types of alopecia areata is the same as in the previous
study [5]. The percentage of sisaipho is 0.3%, which is the same as three
years ago [1], similar to the percentage observed in other countries [2],
and it is particularly specific to children [1, 2, 6]. Secondly, it is
the first time that we have seen alopecia areata type MAGA advancing in
a wave-like form, causing loss of all hair in the frontovertical area
producing a pattern of a high Hamilton degree male androgenetic alopecia,
that finally could be considered as a sisaipho or ophiasis inversus. This
is a particular form of evolution in waves, as described in regrowth by
Orecchia [6]. It has a poor prognosis.
Article accepted on 14/10/99
REFERENCES
1. Muñoz MA, Camacho FM. Sisaipho a new form of presentation
of alopecia areata. Arch Dermatol 1996; 132: 1255-6.
2. Muralidar S, Sharma VK, Kaur S. Ophiasis inversus: a rare
pattern of alopecia areata. Pediatr Dermatol 1998; 15: 326-7.
3. Shapiro J, Madani S. Alopecia areata: diagnosis and management.
Int J Dermatol 1999; 385: 19-24.
4. Muñoz MA, Camacho FM. Regrowth of alopecia areata simulating
the pattern of androgenetic alopecia. Arch Dermatol 1997; 133:
114-5.
5. Camacho F, Rodríguez-Pichardo A, García-Bravo
B. Estudio clínico y epidemiológico de la alopecia areata
en el sureste de España. Actas Dermosifiliogr 1992; 83:
347-9.
6. Muñoz MA, Camacho FM. Sisaipho. Why ophiasis inversus?
Pediatr Dermatol 1999; 16: 76.
7. Orecchia G, Rabbiosi G. Patterns of hair regrowth in alopecia
areata. Dermatologica 1988; 176: 270-2.
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