This is the NHS paper written about my case

 Not sure if you can read the text properly so copied the information below 

Seasonal relapse of alopecia areata: a model for

environmental triggering

Gordon Hale1, Kid Wan Shum2, Andrew Messenger1

1 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

2 Derby Teaching Hospitals NHS Foundation Trust, Derby, UK

Case Report

 A 41-year-old nurse presented with

a 15-year-history of annual

recurrence of alopecia areata

occurring in a seasonal pattern. At

the beginning of August each year

she would develop patches of

alopecia on the scalp, increasing in

size until the end of December. Her

hair would begin to re-grow in the

following spring, only for the cycle

to repeat itself at the beginning of

August each year.

 The degree of annual hair loss has

progressed and the patient now

develops alopecia totalis each year

by mid-winter followed by total hair

re-growth which would begin the

following spring. She reports a

personal history of seasonal rhinitis

and atopic dermatitis, in addition to

a family history of atopy.

Discussion

 Alopecia areata (AA) is a chronic

autoimmune inflammatory disease

that causes a disturbance in the

normal hair cycle. It is thought that

the autoimmune response

precipitating conversion of anagen

follicles into telogen is triggered by

an interaction between genetic and

environmental factors.

 There is a well-known association

between alopecia areata and atopic

disease, particularly atopic

dermatitis. For example, in a large

population-based study from

Taiwan there was near four-fold

increase in the risk of atopic

dermatitis in patients with AA1.

 Annual hair loss progressing to

alopecia totalis in association with

flares of seasonal rhinitis has been

previously reported2

.

Summer Autumn

 Early-onset and severe AA has

also been linked to dust mite

allergy3. It is possible therefore that

seasonal flares of AA in our patient

are related to activation of her

seasonal rhinitis.

 A second and not mutually

exclusive explanation is that AA

can be triggered by events

associated with anagen-to-telogen

conversion. Seasonal change in

human hair growth is a recognised

phenomenon, albeit much less

pronounced than in other

mammals, with a peak in the

number of hair follicles entering

telogen during late summer4. Other

likely triggers for episodes of AA,

including emotional stress and

childbirth, may also lead to an

increase in anagen-to-telogen

conversion.

Conclusion

 This exceptional case highlights the

complex interchange between

genetic susceptibility and

environmental factors in the

aetiology of AA. The role of

environmental factors in AA has

been little explored but may be a

fruitful target for future research

aimed at understanding the

pathobiology.

Spring Winter

References

1. Chu S et al. Comorbidity profiles among

patients with alopecia areata: The

importance of onset age, a nationwide

population-based study. J Am Acad

Dermatol 2011; 65: 949-56

2. Crosby D, Gammon W. Seasonal alopecia

with atopy. J Am Acad Dermatol 1989; 21:

806-7

3. Li SF, Zhang XT, Qi SL et al. Allergy to

dust mites may contribute to early onset

and severity of alopecia areata. Clin Exp

Dermatol 2015; 40: 171-6

4. Randall VA, Edling FJ. Seasonal changes

in human hair growth. Br J Dermatol 1991;

124: 146-51