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3). The scalp is the most common site affected Tryptophan synthase by AA (90%) Tan et al., 2002?and?Camacho, 1997. Scalp and body hair such as eyebrows, eyelashes, beard, underarm hair, and pubic hair may be affected (Alopecia Totalis), as well as the entire body (Alopecia Universalis). The ophiasis pattern refers to a severe form of AA extending along the posterior occipital and temporal scalp margins. The affected skin appears normal with no grossly evident epidermal alterations such as scaling or follicular abnormalities (Diana Draelos, 2007). In all forms ��exclamation point hairs�� are found, that become narrower along the length of the strand closer to the base may be seen within or around the areas of alopecia (Cline, 1988). Upon regrowth, hair often initially lack pigment resulting in blonde or white hair (Finner, 2011). Nail changes can be seen in a portion of patients (10�C66%) of AA. Small shallow pits (30%) up to trachyonychia (sandpaper nails; 10%) are typical, rarely other changes can also be seen. A red-spotted lunula and periungual erythema have been postulated as a sign of acute nail involvement (Olsen, 2003). Hair pull tests conducted at the periphery of the lesion may be correlated with disease activity and also assist in determining the etiology of alopecia. A few clinical tests are presented below: ? The pull test: this test helps to evaluate diffuse scalp hair loss. Gentle traction is exerted on a group of hair (about 40�C60) on three different areas of the scalp. The number of extracted hairs is counted and examined under a microscope. Normally, 10 hairs are obtained, Selleckchem AZD9291 the pull test is considered positive. Nails as described earlier, show changes in the form of pitting or trachyonychia (Olsen et al., 2004). Stigmata of organ specific autoimmunity may be present on systemic examination. Researchers have devised a clinical scale in order to assess the severity of AA (Ay Se et al., 2000), presented as follows: 1 Mild: Three or less patches of alopecia with a widest diameter of ZD1839 order has devised ��Severity of Alopecia Tool score�� (SALT score) Price and Gummer, 1989. Scalp is divided into four areas namely, Vertex �C 40% (0.4) of scalp surface area; right profile of scalp �C 18% (0.18) of scalp surface area; left profile of scalp �C 18% (0.18) of scalp surface area; Posterior aspect of scalp �C 24% (0.24) of scalp surface area. Percentage of hair loss in any of these areas is percentage of hair loss multiplied by percent surface area of the scalp in that area. SALT score is the sum of percentage of hair loss in all above mentioned areas. Though alopecia areata is a form of non scarring alopecia, it is sometimes confused with different varieties of scarring alopecia as well. This is also because many alopecia types are biphasic in their natural history.