Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Alopecia Areata


Related Terms

  • Alopecia
  • Baldness
  • Patchy Hair Loss

Differential Diagnosis

  • Alopecia due to radiation or other skin damage
  • Androgenetic alopecia (male pattern baldness)
  • Discoid lupus erythematosus
  • Female diffuse baldness with genetic and hormonal causes
  • Folliculitis decalvans
  • Fungal infection(s)
  • Lichen planopilaris
  • Telogen effluvium
  • Trichotillomania

Specialists

  • Clinical Psychologist
  • Dermatologist
  • Psychiatrist

Comorbid Conditions

  • Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
  • Excessive stress
  • Hormone imbalance
  • Psychiatric disorders
  • Skin conditions such as eczema and vitiligo

Factors Influencing Duration

Although there is no physical disability associated with this disorder, it can result in an adjustment reaction with associated short-term disability.

Medical Codes

ICD-9-CM:
704.00 - Diseases of Hair and Hair Follicles, Alopecia, Unspecified; Baldness; Loss of Hair
704.01 - Diseases of Hair and Hair Follicles, Alopecia Areata; Ophiasis

Overview

Alopecia areata is a condition in which hair is lost in patches. Hair loss most commonly occurs on the scalp, but can also involve facial or body hair. The skin in these bald areas looks and feels normal. Hair loss may suddenly slow or stop and then just as suddenly increase in severity. As many as 66% of individuals with alopecia areata also have accompanying nail changes (i.e., pitting, ridging, and rough, thick nails) (Habif 856).

Alopecia areata varies from patchy hair loss to larger areas of little or no hair. In alopecia totalis, on the other hand, all scalp hair is lost and the surface of the scalp becomes totally smooth. Alopecia universalis means loss of all hair on the head and body, including eyelashes, eyebrows, underarm hair, and pubic hair.

Although the cause of alopecia areata is unknown, evidence points to an autoimmune disease, in which the body's immune system forms antibodies against itself, controlled by activated T lymphocyte cells. It appears that the key targets are self-antigens that include follicular melanocyte antigens. A genetic component may also be involved that makes certain individuals more susceptible to hair loss in response to triggering events of infections, introduction of bacterial "super antigens," or follicular damage (Norris). Alopecia areata may be associated with an underlying condition, such as pernicious anemia, Down syndrome, an underactive thyroid gland, a skin disease with milk-white patches (vitiligo), or an inherited tendency to develop allergies (atopy).

Onset of alopecia areata tends to coincide with times of particular stress. White hairs are less affected than pigmented ones, so some individuals have reported that patches of hair appeared to "turn gray overnight."

Because hairless patches on the scalp may be small and covered by the hair growing from surrounding areas, a hairdresser is often the first to notice the condition.

Incidence and Prevalence: Rates are similar in men and women and occurrences are found in all age groups. The overall incidence of alopecia areata is 0.1% to 0.2% (Habif 855).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Sixty percent of individuals affected notice their first bald patch before age 20 (Habif 855). Alopecia areata is suspected to have a genetic origin. In individuals whose first bald patch appears before age 30, familial incidence is 37%; in those whose first bald patch appears thereafter, it is 7.1% (Habif 855).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms include patchy hair loss and sometimes pitted or deformed nails. There may be a history of alopecia areata in other family members. Some individuals complain of an itching or burning sensation before the bald patches appear.

Physical exam: Individuals will present with sharply defined round or oval patches of hair loss with no scarring of the underlying skin. If there is some hair left in the bald patches, it may be fine or broken and easily removed. Patches of alopecia may be seen in the eyebrows, eyelashes, beard, or body hair as well as on the scalp. Pitted or ridged nails are present in 10% to 66% of individuals with alopecia areata (Habif 856).

Tests: A complete blood count (CBC) should be performed to rule out immune system disorders.

Source: Medical Disability Advisor



Treatment

Treatment focuses on relieving symptoms because the cause of alopecia areata is unknown. The most common treatment involves injecting the bald patches with corticosteroids or glucocorticoids. Injections should not be repeated in the same site for at least 3 months.

Treatment is determined by the extent of the disease and the individual's age. Individuals are divided into two groups: those with less than 50% scalp hair loss and those with more than 50% scalp hair loss.

Individuals with less than 50% hair loss may not be treated because there is a possibility that the hair will grow in on its own. Treatment in these individuals includes injecting the bald patches with corticosteroids or glucocorticoids, applying a 5% minoxidil solution, or using a combination of these treatments.

Individuals with more than 50% hair loss may try topical immunotherapy using diphencyprone, PUVA, minoxidil, and cortisone cream, minoxidil and anthralin cream, or systemic steroids. Topical immunotherapy has a 25% chance of producing cosmetically acceptable regrowth (Norris).

Source: Medical Disability Advisor



Prognosis

The disease is highly variable with periods of spontaneous recovery and/or relapse. Individuals with alopecia areata can usually expect regrowth of lost hair within a few months. Treatment with steroids usually reduces this time to 4 to 6 weeks, although renewed hair loss may occur with the discontinuance of steroids (Norris). If the individual has a history of atopic dermatitis or asthma, regrowth of lost hair is less likely. When the hair first grows back, it is usually fine and sometimes unpigmented, but normal hair eventually replaces it.

Source: Medical Disability Advisor



Complications

Practical problems of alopecia universalis include perspiration trickling into the eyes due to lack of eyebrows, little protection from dust and glare without eyelashes, and no protection in the nostrils or sinuses from foreign particles in the air because of a lack of nasal hair.

Because of the cosmetic effects of the condition, it can have disturbing psychological consequences. The unpredictable course of the disease can be confusing and discouraging to the individual. One in 4 adults diagnosed with alopecia areata develop alopecia totalis, in which all scalp hair is lost.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Usually no work restrictions or accommodations are required. The individual may be more comfortable if dress code restrictions are relaxed to allow the wearing of a hat.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of alopecia areata confirmed?
  • Does individual have an underlying condition that may affect recovery? Are underlying conditions being appropriately addressed?

Regarding treatment:

  • Has individual received treatment appropriate for extent of hair loss?
  • What other options can be tried?
  • Would individual benefit from consultation with a dermatologist?
  • Have areas of excessive stress been addressed?
  • Has individual been educated in stress-reduction techniques?
  • Would individual benefit from psychological counseling or enrollment in a support group?

Regarding prognosis:

  • If individual has been doing watchful waiting, is he or she now ready to try a treatment option?
  • Is individual aware that certain underlying conditions may affect hair regrowth?
  • Would individual benefit from psychological counseling or enrollment in a support group?

Source: Medical Disability Advisor



References

Cited

Habif, Thomas. "Alopecia Areata." Clinical Dermatology. 4th ed. New York: Mosby-Year Book, Inc., 2004. 855-858.

Norris, D. A. "Alopecia Areata: Current State of Knowledge." Journal of the American Academy of Dermatology 51 1 (2004): 16-17.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.