title: Ocular findings in patients with alopecia areata: role of ultra-wide-field retinal imaging.
abstract: Alopecia areata is understood as an autoimmune disease T cell-mediated mainly involving hair follicles in humans. It is a multifactorial aetiologic disease characterised by non-scarring alopecia and asymptomatic areas, affecting approximately 2 % of dermatology patients. Recent studies suggest that the pathogenesis of AA plays an important role in the association of certain HLA groups, neuroendocrine parameters and immunogenic factors. During 3 months (March to May 2013) at Hospital Clínic de Barcelona, 22 patients with severe alopecia areata underwent ophthalmic examination to determine whether there were ocular findings in the following parameters: Best-corrected visual acuity on decimal Snellen optotype, anterior segment slit-lamp examination and photograph, intraocular pressure measurement and dilated fundoscopy. Ultra-wide-field retinal imaging with or without red-free photograph was carried out with the Optomap 200 Tx (Optos, DunFermline, UK). Forty-four eyes of 22 patients were analysed [15 females (68.2 %)]. The mean age was 38.9 (SD 13.7) and mean time of evolution was 19.9 years (SD 16.3). Alopecia areata clinical patterns were multifocal [n = 10 (45.5 %)], universalis [n = 7 (31.8 %)], totalis [n = 3 (13.6 %)] and focal [n = 2 (9.1 %)]. Best-corrected visual acuity was 1.0 in almost all patients, but only three eyes (6.8 %) had vision of 0.7. Ocular findings were as follows: madarosis [n = 7 partial loss of eyelashes (31.85 %) and n = 4 total loss (18.2 %)], lens changes [n = 4 (18.2 %)], cataract [n = 3 (13.65 %)]. Ultra-wide fundus photography examination showed peripheral drusen [n = 17 eyes (38.6 %)], white-without-pressure changes [n = 8 eyes (18.22 %)] and peripheral retinal degenerations [n = 3 eyes (6.81 %)]. Ocular findings in patients with alopecia areata are reported and discussed by dermatologic and ophthalmic evaluation.
authors.affiliation: Ophthalmology Department, Hospital Clínic de Barcelona, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain, f.a.andrade@uol.com.br.
authors.forename: Francisco Assis
authors.initials: FA
authors.lastname: De Andrade
authors.forename: Priscila
authors.initials: P
authors.lastname: Giavedoni
authors.forename: Johannes
authors.initials: J
authors.lastname: Keller
authors.forename: Maria Tereza
authors.initials: MT
authors.lastname: Sainz-de-la-Maza
authors.forename: Juan
authors.initials: J
authors.lastname: Ferrando
mesh_terms: D000328:Adult; D000506:Alopecia Areata / Q000150:complications* / Q000175:diagnosis; D002386:Cataract / Q000150:complications / Q000175:diagnosis; D005128:Eye Diseases / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D042261:Retinoscopes; D014792:Visual Acuity