Alopecia Areata

Alopecia Areata

If a person observes massive hair fall on the pillow, hairbrush, or in the bathroom along with patches on the scalp, they may have alopecia areata. The Latin word ‘Alopecia' means baldness, and ‘areata’ means patch. It is an autoimmune disorder that can affect any hair-bearing area on the body especially scalp and will result in hair loss. In people with an autoimmune disease, the immune system attacks on their own body. In alopecia areata, it attacks the hair follicles and makes them come out in clumps.

Though it is asymptomatic it can cause major distress to the patient and/or family. It affects people of all ages, irrespective of gender and race. Although it most commonly appears in adolescence or early adulthood age (before age of 30 years). 

Approximately, 150 million in the world are affected with alopecia areata, amongst, 2.1% had lifetime risk.

Types of alopecia areata

The patchy pattern of the hair loss is common in this condition, however, it can lead to complete loss of hair on the scalp (alopecia totalis) or, the entire body (alopecia universalis). Depending on the type and severity of the disease a person has, the amount of hair loss and body area where hair loss happens may vary.

Symptoms

It develops suddenly over a few days in an otherwise healthy person. Hair loss occurs within a week and grows back again within several months. However, it may or may not fall again, especially, if you have only a few patches. In such cases, spontaneous and full recovery is possible without treatment. The cycle of hair loss and regrowth lasts for years. Around 50% of cases recover within a year. 

The most common symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Although, other body parts like the beard and eyelashes may also get affected.

In 30% of patients, alopecia areata becomes severe and they experience a continuous cycle of hair loss and regrowth. Around 10% of patients develop alopecia totalis or alopecia universalis.

Rarely, in some people, in addition to the hair loss, fingernail and toenail abnormalities such as pits on the surface of the nails are observed.

Causes

The major cause behind the condition is the self-attack of the autoimmune system on the hair follicles. Which makes the hair fall-out, shrinks the hair follicle and slows down the regrowth of hair. The reason behind attacking the hair follicle is still unknown. 

It is partly determined genetically. One in five persons affected with the disease has a familial background. The proportion of positive family history is around 10-20% compared to 1.7% in control patients. The susceptibility and severity of the disease may depend on genetic factors probably due to polygenic defects, however, triggering environmental factors are unknown. There are fewer chances of inheriting the disease unless both the parents are positive. 

A person with alopecia areata with family history may also have other autoimmune diseases. Researchers think it is one of the causes for alopecia areata. 

Stress was not found to play a significant role in alopecia areata.

Diagnosis

Although there are good signs and symptoms of the condition, one should see a doctor for confirming diagnosis. Rarely, in hard to diagnose cases skin biopsy and blood tests to rule out other autoimmune diseases can be performed. However, the percentage of such tests is very low. Only clinical examination of bald patches and microscopic examination of hair are sufficient to diagnose the condition.

Self-care

People with alopecia areata are otherwise healthy and not a sign of cancer.

The first thing one has to do is to consult a dermatologist who can better understand the condition and can give self-care tips. 

  • Try to protect the affected areas from extreme temperatures
  • Mention toe and nail changes to the dermatologist
  • Apply antibiotic topical cream if lost nostril hair
  • Protect the eyes if lost eyelashes or eyebrows by using sunglasses, false eyelashes or eyebrows
  • Cover the head to protect the scalp
  • Get clinical and diagnostic examinations for thyroid disease as recommended by the dermatologist, as people with autoimmune diseases are more prone to other such diseases
  • Try to cope up with the emotions that arise due to hair fall and avoid being stressed out

Take home message

In mild alopecia areata hair regrows on its own without treatment. If failed to regrow hair within a year, treatment can help. Additionally, self-care also plays an important role.

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Treatment

Though autoimmune system attacks on the hair follicles making hair to come out, the hair follicle remains alive. It can regrow again if inflammation at the hair follicle gets subsided. The treatment can only ensure fast regrowth of hair or disrupt or distract the immune attack, although, it cannot cure the condition completely.

Treatment mainly depends on the type and severity of the condition and age of the person. Topical medications are given if a person has milder disease (hair loss <50>50%) oral and injectable medications will be prescribed. Although, one medication won’t work for everyone. Sometimes dermatologists would suggest a wait-and-see approach if someone has lost only a few patches and automatic regrowth is plausible.

The most common medications for the treatment are corticosteroids, Minoxidil, Anthralin, SADBE, and DPCP. The photochemotherapy can be used in patients who are not unsuitable or unwilling for systemic or invasive therapy.

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