An Unusual Pattern of Alopecia Areata

In a letter to the editor, the authors described a case of an unusual presentation of alopecia areata (AA) in a 29-year-old male who experienced extensive hair loss over a 6-month period, affecting all hair-bearing areas except the vertex of his scalp. This pattern did not fit the typical classifications of AA, which include patchy AA, alopecia totalis (loss of all scalp hair), universal AA (loss of hair from all sites), ophiasis (a band-like pattern along the occipital hairline), sisaipho (hair loss centrally with hair spared at the margins), and diffuse AA (sudden diffuse hair loss over the scalp). The patient's condition did not improve after four monthly dexamethasone cyclophosphamide pulses, and he was lost to follow-up. The authors were unable to find similar cases in the literature and were left uncertain whether this was an extensive form of ophiasis with alopecia of other hair-bearing sites or a unique pattern of AA.