الفهرس 
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Abstract
Alopecia areata (AA) is considered to be an organ-specific autoimmune disease mediated by T lymphocytes directed to hair follicles. The exact etiology of AA remains unclear although several genetic and eviromental factors have been shown to trigger the initiation of the disease.
Considerable variations in the clinical presentation of AA have been noticed, ranging from localized, well-circumscribed patches of hair loss to a complete absence of body and scalp hair.
Heavy metals are generally referred to as those metals which possess a specific density of more than 5 g/cm3 and adversely affect the environment and living organisms.
Heavy metals are naturally occurring elements that comprise essential metals as Copper, Ferrous, selenium, Nickel, and Zinc) and nonessential metals as Cadmium (cd), mercury Hg, and lead (Pb).
The potential routes of entry of heavy metals into the body; ingestion of contaminated food; inhalation from the atmosphere, drinking contaminated water; and due to skin contact from agriculture, pharmaceutical, manufacturing, residential and industrial areas.
Cadmium does not only inhibit DNA-repair enzymes but also stimulates ROS production in polymorphonuclear neutrophils, thereby inducing inflammatory response. Smoking is a major cause of nonoccupational Cd exposure. Moreover, smokers have significantly higher concentrations of Cd in urine, blood, hair, and tissue compared to nonsmokers. Krocova et al. reported that Cd and Pb can cause autoimmune diseases by inducing inflammatory response even at lower concentrations. Similarly, Shen et al. noted that heavy metals can cause autoimmune activity by increasing T-cell proliferation.
The aim of the study was to evaluate the levels of cadmium and lead in scalp hair of patients with alopecia areata.
This study was conducted on thirty patients with AA and twenty individuals as control group, recruited from the outpatient clinic of Dermatology, Venereology and Andrology Department, Main University hospital, Alexandria Faculty of Medicine.
All participants were subjected to history taking,clinical examination and trichoscopic evaluation. Analysis of cadmium and lead in scalp hair samples using atomic absorption Spectrophotometry in Atomic Laboratory of Alexandria University.
In the present study , the majority of patients were male 63.3 %. Mean age was 22 years for the patients and 21 years for the healty group. Indoor occupation account for the majority of the cases 73.3%. Majority of the participants were from rural areas 70.5%. Most of the patients were nonsmokers 63.3%.
The majority of the patients had Alopecia areata localized pattern 73.3% followed by Subtotalis pattern about 13.3 % followed by both multilocularis and ophiasis with the same percentage 6.7%.
The majority of patients presented with disease duration 6 months – 1 year followed by those with duration of less than 6months and lastly those with disease duration above 1year. that majority of the patients had dermoscopic signs of activity and most dermoscopic signs were broken hair then vellous then black dots and exclamation marks