Alopecia Areata: Pathogenesis and Clinical Picture

Abstract

The term “alopecia” {άγωπεκíα = fox’s disease) was first used by Hippocrates in the 35th chapter of his book On Diseases. He wrote that the so-called blemishes include “the foxes”, by which he meant that the hair “gets foxy” at particular spots (“areae”). The term was probably coined because “no grass grows where the fox urinates” (Ebstein), but this interpretation was rejected by Richter (1928), who claimed that the Indian source allegedly quoted by Ebstein did not exist. The term “area” is known from Celsus, a contemporary of Virgil. In the 4th chapter of his 6th book, Celsus wrote “arearum quorum duo genera sunt”, i.e., there are two types of baldness: “… the form which leads to slight fattiness and complete baldness of the skin is worse. The form termed “alopekia” may take any shape. It originates in areas covered with scalp and beard hair. But the type which is called “ophiasis” (ἤ#x03D5;ιξ = snake), because of its similarity to the windings of a snake develops from the back of the head, more than two fingers in width, and its two ends creep on towards the ears and the forehead, where they meet. The former may occur at any age, while the latter is usually seen in children only. The former hardly ever heals without treatment, the latter frequently heals spontaneously…” (Celsus). According to Montgomery (1931), the term “area” was used by Virgil to mean a circular place similar to that where the grain was threshed. On the other hand, the chaff remaining on the threshing-floor makes one think of “favus” rather than the smooth, candlewax-white spot characteristic of alopecia areata. It is assumed that Celsus himself was only the translator of a medical work written by the Greek Menekrates, a personal physician of Tiberius.