Give images of alopecia areata.

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Here is a comprehensive visual gallery of alopecia areata (AA) across its clinical presentations and diagnostic features:

Alopecia Areata — Clinical Images

1. Ophiasis Pattern (Band-like Hair Loss)

Alopecia areata — ophiasis pattern along the occipital hairline

Well-demarcated, smooth alopecic patches following the lower posterior scalp margin in a band pattern. Ophiasis is associated with a more treatment-resistant course.

2. Extensive Patchy Alopecia Areata

Alopecia areata — multiple large patches with intralesional treatment marks

Multiple large, well-demarcated non-scarring bald patches. Small erythematous puncta visible from intralesional corticosteroid injections. Remaining hair is normal in density, highlighting the contrast with affected areas.

3. Disease Progression & Regrowth Timeline

Alopecia areata — progression from initial patch to full regrowth and relapse

Panel A: Single circumscribed vertex patch (~5×6 cm) with exclamation-mark hairs
Panel B (Days 68–196): Progressive regrowth from vellus to terminal hair
Panel C: Disease relapse (Day 337) — multiple smaller patches
Panel D: Complete regrowth — illustrates the fluctuating, relapsing-remitting nature of AA

4. Diffuse/Patchy Pattern (Immune Checkpoint Inhibitor-associated)

Alopecia areata — diffuse patchy pattern with erythema

Irregular, non-scarring diffuse thinning over the parieto-occipital region with mild erythema. This pattern can occur as an immune-related adverse event (irAE) during immunotherapy for cancer.

5. Classic Focal Patch — DermNet

Alopecia areata — classic well-demarcated bald patch, DermNet

A sharply demarcated, round-to-oval non-scarring patch on the temporal scalp. The skin surface is smooth without scaling or scarring — classic for non-cicatricial alopecia.

6. Dermoscopy — Exclamation-Mark Hairs (Active Disease)

Trichoscopy of alopecia areata showing exclamation mark hairs and regrowing hairs

Dermoscopic view:

Red arrow: Exclamation-mark hairs — tapered proximally, thicker distally — pathognomonic of active AA
Yellow arrow: Regrowing hairs — thicker, pigmented shafts indicating follicular recovery

7. Dermoscopy — Before & After Treatment

Trichoscopy before and after treatment for alopecia areata

Panel A (Baseline): Yellow dots (keratin-filled follicular ostia), black dots (broken hairs at scalp surface), exclamation-mark hairs — markers of active disease
Panel B (Post-treatment): Normal hair density restored with 1–2 terminal hairs per follicle; pathological markers resolved

8. Pathogenesis Diagram — Fitzpatrick's Dermatology

Mechanism of alopecia areata — CD8+ T cells, IL-15, JAK inhibitors

CD8⁺ T cells, supported by IL-15, attack anagen hair bulbs and drive premature catagen transition → hair loss. JAK inhibitors suppress this T-cell inflammation and directly promote hair growth. (Fitzpatrick's Dermatology, Vol. 1–2, Fig. 13-4)

Key clinical features visible across these images:

Feature	Significance
Round/oval smooth bald patches	Classic AA presentation
Non-scarring scalp surface	Differentiates from cicatricial alopecias
Exclamation-mark hairs (dermoscopy)	Pathognomonic of active disease
Yellow dots (dermoscopy)	Follicular ostia — preserved follicles
Black dots (dermoscopy)	Broken hairs at scalp surface
Ophiasis pattern	Poor prognosis variant
Hair regrowth (often white initially)	Spontaneous remission possible

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