Personal Ethics Research Paper Example | Topics and Well Written Essays - 1000 words

Personal Ethics - Research Paper Example My personal opinion on ideology to cultivate a better human character, therefore, is largely based upon the notion of developing all these character traits in an individual’s personality and life. Businesses being the major part of the modern life also need to depict an ethical business behavior, because their behavior must be in consistence with the values and ethics as agreed by society. Failure of any business to actually comply with what society considers as acceptable and ethically good must be a top priority of all the business. As such it is critically important that our ethical system - whether it is at the personal or business level - must demonstrate certain principles which ultimately shape our real character and orientation towards society and how we approach it. It is critical for the reason that we must first describe our underlying ethical principles. My individual ethical system is based upon the ideology of cultivating character which is based upon the traits described above. I honestly believe that in order to live an ethical life, it is critically important to first actually develop the character. Cultivating fairness, honesty and showing responsibility are some of the basic ingredients of my ethical system. (Josephson Institute, 2012). The primary principles of my ethical system include living with honesty, fairness, and duty realization while at the same time complying with the morals, ethics and values set by the society in which I live. Religion has been one of the keys to shape my overall ethical system, as I believe that it has the power to actually shape the way we make distinction between right and wrong. Apart from this, my experience with the world, so far, has also provided me an insight into developing an ethical system based upon the notions outlined above. I truly believe that my ethical system is a duty

The task is to review EuroJet's foreign exchange exposure Coursework

The task is to review EuroJet's foreign exchange exposure - Coursework Example In addition to this, as has been noted in the case study that the company plans to opt for one of the two options for expansion, which include expansion of network to intercontinental destinations and growth of existing network, the report also provides an evaluation of the risks associated with these two options in terms of foreign exchange risk and international environment risks. Besides this, a critical review of the literature pertaining to foreign exchange risk has been provided in the appendix at the end of this report. Management of Foreign Exchange Risk Having noted the fact that Euro Jet is faced with a risk of foreign exchange exposure due to fact that its revenues are earned under different currencies’ denominations, it is therefore pertinent to understand first that what is foreign exchange exposure risk and how it influences a company’s revenues. Moreover, the understanding of different risks and methods to manage them is likely to result in determining an approach which is more suited to the needs and requirements of Euro Jet. Foreign Exchange Exposure Risk The foreign exchange exposure risk refers to the expected gain or loss incurred due to fluctuations in the exchange rate (Arnold & Kumar, 2008; Moles et al., 2011). The foreign exchange risk resulting from fluctuations in the exchange rate may impact the overall cash flows, revenues, assets and liabilities and other items of financial statements of a company. In other words, the changes in foreign exchange rates result in the changes in a firm’s value, which may be favourable or an unfavourable change (Madura, 1989). Companies having operations in more than one country, like Euro Jet, are projected to risks associated with foreign exchange fluctuations. The risks associated with foreign exchange fluctuations may be categorised into three main types, which are as follows: Transaction Risks This risk relates to the risks associated with cash flows, i.e. the impact of changes in the exchange rates on revenues receivable, expenses payable, and other payments to be made to shareholders and third parties (Arnold & Kumar, 2008; Moles et al., 2011). Translation Risks This risk refers to the impact of change in foreign exchange rates on the value of a company. The impact of changes in foreign exchange rates is translated and reflected in the balance sheet of the company (Arnold & Kumar, 2008; Moles et al., 2011). Economic Risks This risk relates to the exchange rate fluctuations translated in the present value of operating cash flows to earned in future by a company. In other words, this risk relates to impact of changes in foreign exchange rates on the earnings of a company (Arnold & Kumar, 2008; Moles et al., 2011). Keeping in view this discussion of the foreign exchange risk and its various types, the approaches for managing foreign exchange exposure risk can be discussed as under. Approaches for Managing Foreign Exchange Exposure Risk In order to manage f oreign exchange exposure risk, the most common and widely applied approach by both financial and non-financial business entities is the use of hedging. However, hedging has also various types and therefore various hedging approaches can be followed by business entities, and particularly by Euro Jet. Hedging refers to dealing with risk for a company resulting from exposure to

UK public finances Essay Example | Topics and Well Written Essays - 1000 words

UK public finances - Essay Example According to forecasts published by the HM Treasury for the month of June -July 2010 and June - July 2011, it is evident that GDP during the same period will increase from 1.2% to 2.1% respectively (HM Treasury Report July, 2010) The detailed overview of the public finances databank available from the government, it is revealed that the current budget surplus is -105.6 billion and net borrowing of 154.6 billion with overall net debt of 53.8% for the year 2009-10. It is further evident from the data below that the trend in net borrowing is decreasing thereby promoting the growth of GDP. The table below shows that current budget surplus has come down to zero resulting in healthy GDP of 67.4% by 2014-15. (Table 1) The data furnished above should motivate the executives and decision makers to invest in the country eyeing the long term objective of making profit. However the following diagram shows that most of expenditure is targeted towards social protection which aggregates to 28%, which is understood in the present circumstances of continuous threat of terror attacks. Health and Education is also one of the important areas where the government is spending huge money. According to following diagram, it is suggested that company executives may invest in other areas like housing loans and insurances as the government spending in those areas is very minimal. It is forecasted that the government would receive majority of its income from tax deductions, which means good income to the public, followed by National Insurance (17%). Figure 1 Figure 2 (Source: Public Sector Finances Data Bank - HM Treasury http://www.hm-treasury.gov.uk) The government received 153.5 billion as Income Tax in the year 2008-09, 96.9 billion from National Insurance, 78.4 billion from VAT and also from tobacco duty, fuel duty, spirits, wine, beer and cider duties, air passenger duty. As mentioned above, company executives may focus on providing products and fix prices keeping in view the predicted spending and generated income by the government. As the diagram (Figure 1) shows that government spending is huge in social protection but least in housing and environment, it is assumed that opportunity persists for the businesses in realty and banking sector. It is assumed that banking sector will flourish during the next few years as financial assistance could be provided to the people from agricultural sector as well as in realty sector. (http://www.hm-treasury.gov.uk) It is important to mention that economics uses theories and methods to study the behavior of people involved with allocating resources and aiming to reach some optimum situation (Elliott and Payne, 2005:1). As the government is

Leadership Discussion Essay Example | Topics and Well Written Essays - 250 words

Leadership Discussion - Essay Example anization, a leader can challenge the process by first diagnosing all possible causes of a known process problem so that the same does not hinder success of new ones. Banks always use business analysts to help capture the current processes in the banks and what the external environment feels about them. With such audits, it is pretty easy to make actionable conclusions on whether to make modifications on the existing process of coming up with a new one. In challenging the process, especially in the pharmaceutical industry, a leader must understand the interrelations and integration that exist among all the data documents. This is critical in the challenging process because it provides tangible information on the patterns and the necessity for change. Success demands first hand involvement, and that is why most experts say, â€Å"If you want something done right, do it yourself.† Being involved is a sure roadmap to freedom because decisions are made depending on the situations, capabilities, expertise, and objectives. However, as a leader, it is admirable if you empower employees to handle tasks under little or no supervision. To make it a success, however, leaders must be willing to help the subordinates in cases where procedures are complex or decision making is critical. Being a leader requires a will more than being a manager. Challenging processes give room for creativity, detachment from the old fashion norms, and keeps the organization streamlined to the mission, vision, and goals. However, to make it a success, leaders must be involved in ensuring everything done is as per the requirements. Direct interaction with subordinates, getting involved in the processes, and making tangible decisions is a sure way to overcome

Renaissance Essay Example for Free

Renaissance Essay Renaissance is a French word that literally means â€Å"Rebirth† and is referring to the rebirth of learning in northern Italy after there was hardly learning in the middle ages. During the Renaissance, there was a great renewal of education and ancient times. But, the Renaissance was more than just studying works of ancient scholars; it influenced sculpture, architecture and painting. In Leonardo da Vinci’s Mona Lisa, the mysterious smile reflects the newly emerging Renaissance values of Humanism and The Renaissance man. (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Renaissance. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Leonardo da Vinci. ) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Mona Lisa†) Humanism was a new philosophical outlook that rejects religious beliefs and centers on humans and their values, capacities, and worth. For example some human achievements and concerns were the study in philosophy, culture, human needs, desires, and experiences. Humanism not only influenced the Renaissance, it also assisted the creation of art during the Renaissance. For example most of history’s famous painters lived during the Renaissance. In Leonardo da Vinci’s Mona Lisa, humanism is shown by her mysterious facial expression, which gives an indication that she’s keeping a secret. Humanism was key to the Renaissances success in art and learning because it got peoples minds off religious beliefs and allowed them to focus on human values like artwork. (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Humanism. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Leonardo da Vinci. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Mona Lisa†) The Renaissance man was a major title during the Renaissance and almost every man wanted this title. The Renaissance man is a flawless individual who tried to master all areas of study. For example Leonardo da Vinci was considered a Renaissance man because he was a musician, architect, sculptor, painter, scientist, engineer, mathematician, geologist, inventor, cartographer, anatomist, botanist and writer. Leonardo da Vinci’s Mona Lisa was an example of Leonardo da Vinci’s title of a Renaissance Man because this artwork showed how talented he was by creating her mysterious smile. Today, the Mona Lisa’s mysterious smile is being debated why Leonardo da Vinci made it that way. The Renaissance man is a value of the Renaissance because this encouraged more scholars to learn and study so they have something to earn. Encyclopedia Britannica, 11th ed. , s. v. â€Å"Renaissance Man. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Leonardo da Vinci. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Mona Lisa†) In Leonardo da Vinci’s Mona Lisa, the mysterious smile reflects the newly emerging Renaissance values of Humanism and The Renaissance man. The realizations of the Mona Lisa demonstrated how much art had changed compared to the middle ages. Renaissance art was a huge contribution to the Renaissance and in fact expressed the values of it. (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Leonardo da Vinci. †) (Encyclopedia Britannica, 11th ed. , s. v. â€Å"Mona Lisa†)

Determine The Motivation Factors Tourism Essay

Determine The Motivation Factors Tourism Essay 1.0 Introduction This chapter is an introductory chapter. It intend to discuss on background of the study, highlight the problem statement, depict research objectives and questions and explain significance of the study, provide outline of the study and sum up a conclusion of this chapter. 1.1 Background of the Study Before year 1997, the insurance companies in Malaysia are operating as private company complied by the Insurance Act 1963. Yet, followed by the enactment of Insurance Act 1996 which started into force on 1st January 1997, all the insurance companies are converted to public company which licensed by the Ministry of Finance under the Companies Act 1965 (Bank Negara Malaysia [BNM], 2005). The growth of the insurance industry is closely related to the domestic economy of Malaysia. Based on the financial performance, the revenue of insurance industry in Malaysia is increasing gradually year by year. It had shown that an increase of RM 1,110,806 or 7.87% in the income of insurance industry in Malaysia in year 2010 as compared to year 2009. Income of RM 14,114,618 and RM 15,225,424 are recorded respectively for year 2009 and 2010 (Malaysia Insurance Institute, 2010). Meanwhile, the number of registered agents is also growing up year by year. There was a growth from 116,008 agents in year 2009 to 122,399 agents in year 2010, which was increased by 6,391 agents (BNM, 2010). Motivation is the part of commitment and results in achieving the organizational objectives at the appropriate way. Job satisfaction of employees can be motivated by different motivation factors (Balachandar, Panchanatham Subramanian, 2010). According to Tripathi (2001) most of the companies usually motivate their employees by offering economic reward, recognition, promotion, job security, training and authority. When customer comes to buy insurance, very few people contact an insurance company directly, the insurance agent play the role to solicit and sell insurance policies to the general public. No doubt, the revenue of insurance industry is very much depending on the sales gained by the insurance agents. Hence, motivation plays a great role to encourage insurance agents to work professionally in delivering their services to customers. Insurance agents will feel satisfied with their job when companies apply the motivation factors correctly on them. Insurance companies motivate their insurance agents by giving rewards such as extra bonus or company trip to appreciate their effort in getting sales for the insurance company. 1.3 Problem Statement Nowadays, more people want to become insurance agents, which led to the increased of challenges. The statistical report of Bank Negara Malaysia stated that the number of registered insurance agents had increased 5.51% from 2009 to 2010 (BNM, 2010). Normally, insurance agents do not have any basic salary but their pay is based on commission. Insurance agents try to retain and increase their target productivity in order to satisfy their jobs, save their jobs and increase their well-being because the wages of insurance agent depends on a commission basis (Christopher, 2007). According to Bakos (2008) insurance agents retain in the company is highly influenced by commission as remuneration. If the commission to the insurance agents is low, it will de-motivate them and leads to resignation. Past studies showed that motivation and job satisfaction have direct relationship to influence employee retention and performance among various types of organization (Goleman, 1998). According to Cravens, Ingram, LaForge and Young (2010) giving a right tool of training and development can motivate insurance agents more successful in selling life insurance products. Training and development can improve the job skills and knowledge of insurance agents at each level. Therefore, employees should be given more opportunities for advancement to motivate them in order to enhance their job satisfaction level (Feinstein, 2000). Besides, Tripathi (2001) stated that employees can be motivated by job security, recognition, promotion and training to enhance job satisfaction. There are several past researchers Hassan (2010), Salleh, Dzulkifli, Abdullah and Ariffin (2011), Golshan, Kaswuri, Aghashahi, Amin and Ismail (2011) studies on the relationship between motivation factors and job satisfaction among nurses, state Government employees and Gen-Y administrative and diplomatic officers in Malaysia but lack of studies on insurance agents in Malaysia. The objective of this research is to investigate the relationship between motivation factors and job satisfaction among insurance agents in Malaysia. 1.4 Research Questions and Objectives 1.4.1 General Objective The major objective of this research is to identify and determine the motivation factors that influence job satisfaction of insurance agents in Malaysia. 1.4.2 General Question What are the motivation factors that influence job satisfaction of insurance agents in Malaysia? 1.4.3 Specific Objectives To investigate whether commission pay influence insurance agents job satisfaction in Malaysia. To investigate whether job security influence insurance agents job satisfaction in Malaysia. To investigate whether opportunities for advancement and development influence insurance agents job satisfaction in Malaysia. To investigate whether work itself influence insurance agents job satisfaction in Malaysia. 1.4.4 Research Questions Will commission pay influence insurance agents job satisfaction in Malaysia? Will job security influence insurance agents job satisfaction in Malaysia? Will opportunities for advancement and development influence insurance agents job satisfaction in Malaysia? Will work itself influence insurance agents job satisfaction in Malaysia? 1.5 Significance of the Study This research is tending to contribute to the individual and companies. To through this research, the insurance companies will know the importance of the insurance agents job satisfaction and knowing the level of job satisfaction of insurance agents. Meanwhile, individual can also gain a better understanding on motivation factors that can lead them to job satisfaction. The second aim of this research is to narrow the gap with regards to understanding job satisfaction of insurance agents by studying the motivation factors that influence insurance agents job satisfaction. Insurance companies will get to know more about the motivation factors that influence the insurance agents job satisfaction by offer some rewards system to satisfy insurance agents. This enables them to build long-term profitability and retain continuous growth in their businesses to gain competitive advantages in the insurance industry. This research will also expose a new knowledge to the public who has interest on the job of an insurance agent. It assists the public on raising knowledge and awareness of motivation factors that influence the job satisfaction of the insurance agents. 1.6 Outline of the Study Chapter two shows the related literature review that provides the foundation for developing the theoretical framework to proceed with further investigation and hypotheses testing. Chapter three presents the research methodology used to test the research questions. It includes research design, population, sample and sampling procedures, data collection method, variables and measurement, and data analysis techniques. Chapter four is the description of the data analysis. It presents the overall result and findings from the data collection. Statistical Package for Social Science (SPSS) is used to generate results in this research. Chapter five is summaries the research finding and also discusses the major finding. Besides, it also discusses the limitation of the study as well as provides the recommendation for future researchers. 1.7 Conclusion This chapter is about the overview of this study stated on the above. This study aims to determine the motivation factors affecting toward insurance agents job satisfaction so as to contribute for insurance companies and the public. In the following chapter two, it will provide the literature review of this study.

Alopecia Areata: Causes, Types and Symptoms

Alopecia Areata: Causes, Types and Symptoms Alopecia areata can affect any hair-bearing area and can also involve nails. A peribulbar lymphocytic infiltrate in a swarm of bees pattern is characteristic of the acute stage of the disease leading to a dystrophic anagen phase. There may also be increased psychiatric morbidity in patients with alopecia areata. Ikeda (2) classified alopecia areata into four types including the common type (81%), the atopic type (10%), the autoimmune type (5%) and the prehypertensive type (4%) The course of the disease is unpredictable and the response to treatment is variable. The various treatment modalities used can be classified into topical and systemic therapies. The topical therapy includes intralesional corticosteroid, topical corticosteroids, minoxidil, anthralin and topical immunotherapy in the form of diphenylcyclopropenone (DPCP) and squaric acid dibutylester (SADBE). The systemic therapy includes systemic corticosteroids and photochemotherapy. Cyclosporine, methotrexate, sulphasalazine and biologics like etanercept, efalizumab, adalimumab and infliximab have been used with limited success. Intralesional corticosteroids are the treatment of choice for adults with less than 50% of scalp area involvement. The sensitivity of picking up clinical response to treatment by a clinical examination is very variable and has interindividual variation. Dermoscopy is a noninvasive diagnostic tool which visualizes subtle patterns of skin lesions not normally visible to the unaided eye. It is performed by a hand held or a video dermoscope equipped with lenses that currently allow magnifications ranging from 10 to 1000, the images obtained can be visualized on a monitor and stored using specific software on a personal computer, to identify and compare changes over time.(3) The characteristic features of alopecia areata on dermoscopy (4) are yellow dots, black dots, broken hair, vellus hair and tapering or exclamation mark hair. After therapy there is a decrease in the number of these characteristic findings. On the other hand, the presence of thin and unpigmented vellus hair within the patch, and evidence of transformation of vellus hair into terminal hair, appearing as increased proximal shaft thickness and pigmentation, are characteristic of remitting disease and indicative of a response to treatment. The present study is being undertaken to evaluate the efficacy of intralesional triamcinolone acetonide in the treatment of alopecia areata and to assess its local and systemic side effects. Dermoscopy has been used to identify signs of early clinical response to the chosen therapeutic regimen. The useful markers to assess the severity of alopecia areata on dermoscopy are the black dots, yellow dots, broken hairs or dystrophic hair, tapering or exclamation mark hair and short vellus hairs. Previous reports have suggested that the severity of alopecia areata is an important prognostic factor. Therefore, dermoscopic examination of patches of alopecia areata may provide predictors of the response to therapy and can also be utilized for monitoring response to any prescribed regimen. Definition Alopecia areata is an autoimmune disease of uncertain etiology that involves the hair follicle and sometimes the nail and is usually reversible. Although autoimmune, genetic and environmental factors have been implicated but the exact pathogenesis is yet to be elucidated. History Hippocrates first used the term alopecia which literally means foxs disease. The characteristics of alopecia areata were first described by Cornelius Celsus in 30 A.D., who described two forms of alopecia. The first he described as complete baldness occurring in people of all ages. The second he called ophiasis, which literally means snake, due to the pattern in which the hair loss spreads across the scalp and also suggested that ophiasis was only seen in children. Alopecia areata is sometimes also referred to as area celsi in tribute to Cornelius Celsus. Alopecia areata has been given many different names throughout history. However, the actual term alopecia areata was first used by Sauvages in his Nosologica Medica, published in 1760 in Lyons, France. From the beginning of 19th century there was considerable debate about the cause of alopecia areata. Two main hypotheses were put forward, one based on parasitic infection by Gruby in 1843 and Radcliffe-Crocker in 1903 and the other based on a nervous disorder by Von Barensrung in 1858. The parasitic hypothesis drew support from the pattern in which alopecia developed -expanding slowly in size just as a local infection would. Even more significant were the apparent epidemics of alopecia areata reported to occur in institutions such as orphanages and schools. However, many attempts to isolate an infective organism and to transfer alopecia areata by inoculation failed. The initiation of alopecia areata by a nervous disorder, known as the trophoneurotic, neurotrophic or neuropathic hypothesis, eventually gained the support of most dermatologists of the time. This vague hypothesis could be supported by the apparently frequent clinical observations of emotional or physical stress and trauma that were associated with the onset of alopecia areata and often reported in the medical journals of that time. Emotional stress and physical damage were believed to adversely affect hair follicles via the nervous system and Joseph in 1886 showed that patchy hair loss could apparently be induced by cutting nerves in the necks of cats (it was later suggested that the hair loss was actually due to the cats scratching themselves). The idea circulated among dermatologists for many years because it was very difficult to fundamentally prove or disprove that alopecia areata was a nervous disorder. The hypothesis is still supported by some dermatologists today. One of the more unusual variations on the neuropathic origin of alopecia areata was put forward by Jacquet in 1902 who suggested that alopecia areata was initiated by sources of nerve irritation such as defective and diseased teeth. Jacquets hypothesis was apparently confirmed by Decelle 1909, although Baily in 1910 showed dental disease to be equally frequent in people without alopecia areata. Eye strain was another suggested cause of alopecia areata by Kinnear 1939. With the start of the twentieth century, alopecia areata was known to be associated with disorders of the endocrine glands, particularly the thyroid. As such, some believed the underlying cause of alopecia areata was due to a hormone dysfunction. By the 1920s most dermatologists had abandoned the parasitic theory of alopecia areata and favoured variations on the trophoneurotic and endocrine theories often combining the two. Sufferers of alopecia areata were under extensive mental stress from fear that they would be suspected of having syphilis. Until the advent of antibiotics, syphilis was a widespread, contagious disease and it also often manifests itself by sudden, rapid loss of hair in well-defined patches, just like alopecia areata. Syphilis in the secondary stage can also affect finger nails. To further complicate the matter, some dermatologists suggested that alopecia areata could be found in increased association with syphilis as distinct from the direct action of syphilis on hair follicles. Syphilis was believed to induce alopecia areata by the mental distress it created and its possible upset of the endocrine system. These clearly visible symptoms of syphilis were often confused with alopecia areata by the general population and resulted in social ostracism for the sufferer. The early 20th century saw the development of another hypothesis of alopecia areata induction based on toxic agents. An unknown poison was believed to be introduced to the hair follicle via the blood system inducing hair loss. The sudden remission and relapse of alopecia areata and its action simultaneously over the body was believed to support the idea. Also in support, injection of thallium acetate (rat poison) was shown to induce alopecia areata like hair loss in some patients, with expression of exclamation mark hairs a diagnostic feature of alopecia areata. However, the toxic origin of alopecia areata never gained widespread popularity against the neuropathic and endocrine hypothesis. It is now widely believed that alopecia areata is an autoimmune disease. Even though studies more than 100 years old showed that alopecia areata affected hair follicles were invaded by inflammatory cells by Giovannini in 1891, the inflammatory autoimmune disease hypothesis did not become popular until the 1960s. The idea was first proposed by Rothman in a discussion of a paper by Van Scott in 1958. Treatment of alopecia areata by intradermal corticosteroid injections has been practised for many years. Kalkoff and Macher in 1958 were the first to have reported a series using hydrocortisone. Thereafter, Orentreich et al in1960 and Gombinger and Malkinson in 1961 reported the use of prednisolone and triamcinolone, and Porter and Burton in 1971 used triamcinolone acetonide and hexacetonide. Moynahan and Bowyer in 1965 and Verbov and Abell in 1970 reported the initial use of jet injection apparatuses in a number of conditions including alopecia areata.(6) Epidemiology Alopecia areata occurs worldwide and there is no racial or sex prelidiction. It is a common disease forming 0.7% to 3.8% of patients seen by dermatologists. (7) In the United States, alopecia areata was estimated to occur in 0.1% to 0.2% of the general population, with a lifetime risk of 1.7%.(1) Sixty percent patients present with their first patch below 20 years of age.(8) One study suggests that 85.5% of Asian patients with alopecia areata have disease onset before the age of 40 years.(9) The disease prevalence peaks between the second and the fourth decade of life. A family history is found in 5%-25% of patients.(10) Natural History Natural history that includes the severity, course and prognosis is highly unpredictable and it can be said that the only thing predictable about its course and prognosis is that it is unpredictable. With the available information at present the spontaneous remission rates have ranged from 34% to 80% within one year and 15% to 25% patients progress to total loss of scalp hair (alopecia totalis) or loss of the entire scalp and body hair (alopecia universalis), of which only 10% eventually recover. (11,12) It is a non-scarring alopecia and is reversible but it can be recurrent and abrupt and in long standing cases scarring can occur. Etiology Alopecia areata is a chronic, autoimmune, organ specific disease, probably mediated by autoreactive T cells, which affect hair follicles and sometimes the nails. The increased frequency of other autoimmune diseases favours the above postulation. Hair follicle autoantibodies are also found although it is unlikely that these are involved in the pathogenesis of the disease. Genetic factors: Most reports describe the prevalence of positive family history to be in the range of 10 to 20% but it is believed that some mild cases may be overlooked or concealed and hence the actual figure may be greater. Price and Colombe (13) found a family history of alopecia areata was more common in those who had a disease onset before the age of 30 years (37% compared with 7.1% in those with onset after 30 years). A study amongst monozygotic and dizygotic pairs found a concordance rate of 55% for monozygotic twins and no concordance amongst dizygotic twins.(14) The genetic basis of inheritance appears to be multifactorial and polygenic and not a simple Mendelian pattern. The strongest associations have been with major histocompatibility complex (MHC), particularly the Class II alleles HLA-DQB1*0301 and HLA-DRB1*1104 and the association is linked to chromosome 6p and few susceptibility loci on chromosomes 10, 16 and 18. (15,16) Atopy: Several studies have reported an association and also suggested an earlier age of onset and more severe disease in atopic individuals.(17,18) Autoimmunity: A statistically significant association between alopecia areata and Hashimotos thyroiditis, Addisons disease and pernicious anemia has been reported. It is also associated with other autoimmune diseases like vitiligo, lichen planus, Sjogrens syndrome, systemic lupus erythematosus, morphea, lichen sclerosus, pemphigus foliaceus, ulcerative colitis, myasthenia gravis, autoimmune haemolytic anemia, diabetes mellitus, autoimmune testicular and ovarian disease, Downs syndrome (in which other autoimmune disorders are common) and autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia syndrome (also called as autoimmune polyglandular syndrome-1) which is an autosomal recessive disorder in which there are mutations in autoimmune regulator gene.(19) There is also evidence of circulating organ specific antibodies against thyroid, gastric parietal cell, adrenal tissue, smooth muscle, testis and the ovaries. The cells in the lower part of hair follicle have low or absent expression of MHC proteins and the loss of this immune privilege leading to induction of CD8+ T cell-mediated immunity against follicular melanocytes is hypothesized to be causative of alopecia areata. This explains the peribulbar lymphocytic infiltrate and also the sparing of white hair in the patch and hence leads to what is commonly called as the phenomena of overnight greying. Environmental factors Infection: Prior notion of alopecia areata being due to infection directly or due to a remote focus of infection has a long history and was very popular till the middle of 20th century. Skinner et al (20) reported finding mRNA for cytomegalovirus in alopecia areata lesions. Few reports of coexistence in husband and wife but many have refuted this and likened it to be a mere coincidence. Stress: Is suggested to be an important precipitating factor and this also explains cures by sleep therapy, reassurance and suggestion therapy. Such patients may also have stress associated depression and the finding of elevated serotonin levels in such patients lends support to the theory. It has been seen that there is aberrant expression of estrogen receptor -1 in the hair follicles of diseased mouse with alopecia areata. Corticotrophin releasing hormone (CRH) can induce mast cell differentiation from hair follicle mesenchyme and the CRH/receptor activity is seen to be high in alopecia areata skin.(21) Diet: Iron deficiency has been postulated to modulate the hair loss in alopecia areata. The mechanism is by inhibiting the rate-limiting enzyme for DNA synthesis and hence it diminishes the proliferative capacity of hair follicle matrix cells.(22) It has also been seen that dietary soy intake increases the resistance to the development of alopecia areata. A study in a Japanese population living in Hawaii, where a Westernized non soy diet predominates, showed disproportionally higher alopecia areata incidence.(23) Other factors that have been implicated include hormones, drugs, and vaccinations. These factors may increase or decrease susceptibility to the disease onset, pattern, severity, duration and response to treatment by modifying the physical and biochemical status of the immune system and hair follicles.(24) Pathogenesis and pathology: There are four key phases in the normal hair cycle which includes the anagen (growth) phase, the catagen (regression) phase, the telogen (resting) phase, and the exogen (controlled shedding phase). When the new hair cycle begins the old hair fiber is shed from the hair follicle in the exogen phase and hence this maintains the overall hair density of the scalp. If the exogen occurs before the anagen is renewed or there is a dystrophic anagen then this leads to a state called kenogen in which there is no hair fiber in the hair follicle.(24) Thus the patch of alopecia areata can be said to be in a state of kenogen. When the amount of inflammatory infiltrate around the hair follicle increases this can lead to miniaturization of the hair follicles and shortening of the hair cycle with rapid changes from anagen to telogen leading to the formation of nanogen hair follicles which is an intermediate stage between terminal and vellus anagen.(25) In the acute stage of the disease there is a swarm of bees infiltration of CD4+ and CD8+ lymphocytes into the peribulbar space of anagen stage hair follicles and some penetration of lymphocytes to intrafollicular locations which leads to a state of dystrophic anagen. This disrupts the ability of the hair follicle to produce hair fibres of sufficient length and integrity and the expelled hair fiber is not replaced by a fiber that can produce adequate scalp coverage, hence leading to alopecia.(25) Hair follicles are smaller than normal and do not develop beyond the Anagen 3-4 stage, where the actual hair shaft begins to form and return prematurely to telogen. As more and more hair follicle move to telogen phase the amount of inflammation decreases. At this stage most of the inflammation is localized to the papillary dermis around the miniaturized hair follicles. In all stages of the disease, there can also be a diffuse infiltration of eosinophils and mast cells into the disease affected skin. There is no inflammatory infiltrate which is seen around the isthmus of the hair follicle which is the site for the stem cells. Thus the pathological location of the disease process saves the stem cells from destruction and makes it a reversible and non-scarring alopecia. Trichocytes in the in the hair bulb matrix undergoing early cortical differentiation show vacuolar degeneration and are also the predominant cell types showing aberrant class I and II MHC expression.(10) Classification: Ikedas classification (2) The atopic type (10%) begins during childhood or adolescence and progresses slowly over many years with individual patches lasting more than one year. Ophiasis and reticular patterns are common and the chances of developing total alopecia are very high (30-75%). The autoimmune type (5%), affects the middle aged, runs a prolonged and led to alopecia totalis in 10%-50%. The prehypertensive type (4%) occurred in young adults whose one or both parents were hypertensive progressed faster and led to total alopecia in 40%. Reticular pattern is common. The common type (81%) is the prototype of the fast progressive form of disease that affects adults aged between 20-40 years. No associated conditions and individual patches last less than 6 months and there is spontaneous regrowth occuring within 3 years. Alopecia totalis may develop in 5%-15%. Based on the pattern of alopecia: Restricted to the scalp Patchy Ophiasis Sisaphio Reticulate Diffuse Subtotal Alopecia totalis Generalized Alopecia universalis Clinical features: Alopecia areata may begin at any age but the disease incidence peaks between 20-40 years of age and has an equal sex incidence. The characteristic initial lesion is a well circumscribed, totally bald smooth patch in which the skin appears slightly reddened. The disease is asymptomatic but few patients may complain of itching and burning prior to the onset of the lesions. During the active phase of the disease short easily extractable broken hairs are seen at the margins of the bald patches which are known as exclamation mark hairs and hair pull test is positive.(26) Subsequent course is highly unpredictable. The initial patch may regrow hair or it may increase in size and new patches may appear after a variable interval. The succeeding patches may become confluent. In some cases the initial hair loss is diffuse and total scalp denudation has been reported in 48 hours. Regrowth is initially of fine vellus unpigmented hair and later these assume their normal thickness and pigmentation. It is possible that regrowth may occur in one region while alopecia is extending in another region.(10) Alopecia areata may affect any hair bearing skin but the scalp is involved in 90% of patients. The eyebrows and eyelashes may be associated with hair loss elsewhere or may be the only site affected. The term alopecia totalis (AT) is used when complete loss of all scalp hair occurs and alopecia universalis (AU) when there is loss of all body hair. About 5% of patients progress to AT/AU. A new variant has been described by Sato-Kawamura et al (27) called as diffuse and total alopecia which has a favourable prognosis but has rapid progression and extensive involvement. The disease process preferentially affects the pigmented hair and spares the white hair thus leading to the phenomena popularly known as the overnight greying of hair but this is a relative process as white hairs are also lost albeit less as compared to pigmented ones. Hair regrowth may be initially nonpigmented but later complete pigmentation occurs. Nail involvement occurs in 10%-15% of patients in which the most characteristic feature is fine stippled pitting but sometimes there may also be trachyonychia, red or mottled lunulae, nail thinning and ridging, discoloration that includes longitudinally arranged punctate leuconychia, splitting, onychodystrophy and onycholysis may be seen.(26) Some studies have reported psychiatric diseases like mood disturbances and anxiety and ophthalmological findings like asymptomatic lens opacities and fundus changes.(28,29) Poor prognostic indicators:(10) Early age of onset Extensive scalp involvement (>50% scalp) Loss of eyebrows and eyelashes Alopecia totalis or universalis Recurrent episode Patterns ophiasis, sisaphio, reticular Nail changes: Pits, onychodystrophy, onycholysis, anonychia Associated systemic disorders: atopy, hypertension and connective tissue disease. Associated genetic disorder: Down syndrome Family history of alopecia areata Macrophage migration inhibitory factor (MIF) -173*C gene INVESTIGATIONS: 1. Trichogram/ hair pluck test:(30) To perform the pluck test, hairs are taken from the specified sites on the fifth day after the last shampoo. The surrounding hairs are fixed with clips and 60-80 hairs are grasped with a hemostat covered with rubber. The hairs are plucked, twisting and lifting the hair shafts rapidly in the direction of immergence from the scalp. Hair shafts are then cut off 1cm above the root sheaths and roots are arranged side by side on a slide and then taped. The anagen hair bulbs are seen as darkly pigmented triangular or delta-shaped bulbs with an angle to the hair shaft and there is presence of inner root sheath. The telogen hair is seen as less pigmented hair with club-shaped hair bulb and there is absence of inner root sheath. Anagen hairs are distinguished from the telogen hairs and anagen to telogen ratio is calculated. Trichogram in alopecia areata reveals a mixed telogen-dystrophic pattern. Telogen hairs predominate in the slowly growing patches, whereas dystrophic anagen hair forms the majority in rapidly progressing disease. 2. Scalp biopsy:(10) A peribulbar lymphocytic infiltrate in a swarm of bees pattern is characteristic of the acute stage of the disease, in which the number of follicles is normal and many are in catagen or telogen. In the later stages, only a few lymphocytes or eosinophils are present in fibrous tracts and in a peribulbar location. Many follicles in early anagen stage are observed in this late stage and the actual number of hair follicles may be reduced. 3. Dermoscopy: A dermoscope is a non-invasive diagnostic modality which can be used to visualize fine details of skin lesions and even subsurface skin lesions which are not visible to the naked eye. It is also called as skin surface microscope, epiluminescence microscope or an episcope. An advantage of their use is the storage of the results and their reproducibility. (3) The history of dermoscopy:(31) Skin surface microscopy began in Europe when in the year 1663, Kolhaus used a microscope for examining the small vessels in the nail fold. In 1878, Abbe described the use of immersion oil in light microscopy and this principle was transferred to skin surface microscopy by the German dermatologist, Unna, in 1893. He introduced the term diascopy and described the use of immersion oil and a glass spatula for the interpretation of lichen planus and for the evaluation of the infiltrate in lupus erythematosus. The term dermatoscopy was introduced in 1920 by the German dermatologist Johann Saphier, when he used a used a new diagnostic tool which resembled a binocular microscope with a built-in light source. The term dermoscopy was introduced by Goldman from the United States when he used this new technique for the evaluation of pigmented lesions of the skin. In 1971, Rona MacKie had identified the advantage of surface microscopy for the improvement of preoperative diagnosis of pigmented skin lesions and for the differential diagnosis of benign versus malignant lesions. Dermoscopic patterns of pigmented skin lesions including melanoma were established and standardized in consensus conferences that were held in 1989 in Hamburg and 2001 in Rome. Principle of dermoscopy: (3) The basic principle is to transilluminate a lesion and then to study the same under a high magnification to visualize its subtle features. When light is incident on a skin surface it undergoes reflection, refraction, diffraction and absorption and the magnitude of each of these phenomena is influenced by physical properties of the skin. When light is reflected on a dry, scaly skin surface most of it is reflected back but when the same falls on a smooth, oily skin most of the light passes through it and reaches the deep dermis. Thus certain fluids are used to improve the translucency of the skin that includes oils (olive and mineral oil), liquid paraffin, glycerin and water. Hand-held dermoscope have the basic principles: The refractive index of glass is almost similar to skin and when it is in contact with oil-applied skin, it further enhances the transillumination and hence visualization. The application of a glass plate flattens the skin surface and provides an even surface for better examination. Videodermoscopy represents evolution of dermoscopy and it is performed with video camera equipped with optic fibers and lenses that currently allow magnification ranging from 10X to 1000X, and images are visualized on a monitor and stored using specific software on personal computer. Basic design of a dermoscope:(3) The essential components include: Achromatic lens: To achieve the desired magnification which ranges from 10X to 100X. Inbuilt illuminating system: Various illuminating systems are used that include: Halogen lamps emit yellow light which can alter the colour contrast of the lesions. Light emitting diodes (LED): Used in Delta 20 ©, Dermlite ©, provide high intensity and consume 70% less energy than the halogen lamps. The illumination provided can be adjusted by turning off a set of LEDs. Can also be designed to emit lights of different colors and hence wavelengths and this can help in better visualization of skin as the penetration of skin is directly proportional to its wavelength. Power supply: By batteries eg. Lithium ion battery or using rechargeable handles. The types of dermoscopy instruments that can be used include: Instuments without image capturing facility. Instuments with image capturing facility. Instuments with image capturing facility and analytical ability. Technique: (3) It can be done either by the non-contact or the contact technique. In the contact technique the glass plate of the dermoscope comes in contact with the fluid applied on the lesion whereas in the non-contact technique, there is no contact of the lens with the skin. The cross-polarized lens absorbs all scattered light and hence allows only light in one plane to pass through. The advantage of a non-contact technique is that there is no nosocomial infection but this is eclipsed by poor resolution and decreased illumination. The contact plates used are made mostly of silicon glass and can be graduated for measuring the size of the lesion. These contact plates should be sterilized by using either 2% glutaraldehyde or methylated spirit. It can be used for the diagnosis of melanocytic nevi, melanoma, lichen planus, dermatofibroma, cicatricial alopecia, seborrheic keratosis and to calculate the follicular density in the donor area before follicular unit hair transplantation. Dermoscopy of normal scalp:(32) Dermoscopy of the scalp can be performed with or without interface solution, which is referred to as dry dermoscopy. Dry dermoscopy is useful for observing tertiary structures of the skin, such as hairs, scaling and follicular hyperkeratosis. An interface solution (thermal water) is used to analyse follicular and interfollicular (vascular) patterns. Dermoscopy of the normal scalp shows interfollicular simple red loops, and arborizing red lines, which represents the normal vascular patterns, and honeycomb pigmentation in sun exposed areas and in subjects with darker skin. Follicular units are easily identified and usually contain 1 to 4 hairs. In children, dermoscopy often shows dirty dots corresponding to dust particles retained in the scalp. This feature is not observed in adolescents or adults as sebaceous secretions prevent particle deposition. Dermoscopic findings in alopecia areata: The characteristic findings are yellow dots, black dots, broken hair, tapering hairs corresponding to exclamation mark hair and regrowing vellus hair. Yellow dots: They are due to dilatation of the affected follicular infundibulum with keratinous material or sebum. (4) They vary in size, shape and colour. They may be round or polycyclic, yellow to pink.(33) They may be devoid of hair or contain miniaturized regrowing hair. They represent active and progressive disease. Although yellow dots are seen in androgenetic alopecia, female pattern of androgenetic alopecia, trichotillomania and discoid lupus erythematosus, the number of yellow dots is limited in these conditions as compared to alopecia areata, which shows numerous yellow dots and is its characteristic feature.(34) The incidence of yellow dots reported in the study by Inui et al (4) was 191 of 300 patients and in the study by Mane et al it was 81.8%.(35) It is speculated that this may be the result of yellowish skin colour of Asian patients. Another possible reason may be the different devices used: a handheld dermoscope (DermLite ® II pro) in the study by Inui et al vs. videodermoscopy and a handheld dermoscope by Ross et al (33) and only hand held dermoscope by Mane et al.(35) Black dots: They are remnants of exclamation hair and broken hair. They represent pigmented hairs broken or destroyed at the scalp level. They provide a sensitive marker of disease activity and disease severity.(4) The black dots of alopecia areata are characteristic of black haired individuals, including Asians, and these findings have not been used for the diagnosis of alopecia areata in white population. This feature may be attributed not only to hair colour but also to cuticle resistance. Takahashi et al (36) reported that Asian hair cuticles fall as large pieces while keeping their original shape under extension stress, whereas hair cuticles of white populations tend to collapse to form small fragments. They are also observed in dissecti