Alopecia areata: Causes, Diagnosis, New Treatment
6 Nov 2020
What is alopecia areata?
It is a term for non-scarring hair loss that can occur at any age, in both men and women. It can also affect children. Symptoms of alopecia areata commonly include the coin-sized bald patches that can appear on the scalp, as well as hair loss from the torso, limbs, eyelashes, eyebrows, pubic hair, and beard. Occasionally, it can involve the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia Universalis).
Does the hair grow back?
While regrowth is not guaranteed, in typical alopecia areata, regrowth occurs over a few months or even years. If the hair loss is relatively minor, as in most cases, full hair regrowth usually occurs spontaneously within a year. But where the hair loss is more extreme, it may not all grow back. When hair regrows can be white, at least initially, and you may get further episodes of alopecia areata. It is unpredictable if you get more flare-ups in the future or not.
Causes of alopecia areata
Experts believe that this kind of hair loss occurs when the immune system attacks the growing hair, causing inflammation. The reasons for this auto-immune condition are not fully understood, although extreme stress appears to be a trigger, and about 20% of sufferers have a family history. There are believed to be several genes that can make an individual more susceptible.
Other contributory factors
Some experts believe there is a wide range of contributing factors that make someone more susceptible to developing alopecia areata. Hormones, allergies, viruses, and even toxins might contribute. Probably several factors combined are involved in the activation of the condition in an individual.
Hair growth cycles
Hair follicle growth occurs in cycles consisting of a long growing phase (anagen), a short transitional phase (catagen), and a short resting phase (telogen). At the end of the resting phase, the hair falls out (exogen) and a new hair starts growing in the follicle beginning the cycle again. Hair loss in alopecia areata is a disorder of hair follicle cycling.
Other symptoms of alopecia areata
If you have alopecia areata on the scalp it may be accompanied by a tingling sensation. Another potential symptom is pitted nails, with an appearance like the pin-prick dents in a thimble. The condition tends to start with smooth bald patches without inflammation or scales, although hair loss can be diffused. There may be short, fractured hairs and patches of grey hair in a bald area.
Alopecia areata in men
Along with alopecia areata bald patches appearing on the scalp, men can experience patches of hair loss in their facial hair, as well as the chest and back hair. Male pattern baldness (androgenetic alopecia) is a gradual thinning of hair on the scalp, whereas hair loss from alopecia areata is patchy in the majority of the patients.
Alopecia areata in women
Some hair thinning is common in around 55 percent of women by the age of 70, and this is known as female pattern baldness (androgenetic alopecia). However, alopecia areata can occur at any age. Like with men, it can have a negative impact on self-image, so it’s important to get to the cause and identify appropriate treatments.
What brings about regrowth?
While hair loss can be sudden and develop swiftly, regrowth is slower. Regrowth occurs if the inflammatory response subsides. People with minimal patches often have a full and spontaneous recovery within two years whether or not they receive treatment. But in about 30% the condition persists and becomes more extensive, or they have repeated cycles of hair loss and re-growth.
Addressing the causes of stress in your life is believed to be of help in bringing about regrowth. If your regrowing hair is slow to return to your normal color, ask your hairdresser about dying it. And speak to a dermatologist about treatments to speed up regrowth.
Diagnosing alopecia areata
You may be offered a blood test to identify a medical condition related to the thyroid gland that can be associated with alopecia areata. Also, a pull test and a trichoscopy to determine the stage of the shedding process, and rarely a scalp biopsy, where a tiny skin sample is taken to be checked under a microscope, might also be needed. Vitamin D is also being checked, as deficiency has been linked to unresponsive treatment, so it is important to optimize the levels before starting any treatment.
Alopecia areata treatments
There is a range of treatments, but none are effective for everyone, and some sufferers don’t respond to any treatment. Topical steroid ointments, creams, or applications, as well as intralesional injections of steroids, can be useful in localized disease.
Some physicians use oral steroids, but personally, I don’t like using them as many times hair loss can recur after the discontinuation of the treatment. Minoxidil foam may prevent further hair loss and improve hair density, but you’d need to commit to at least six months of using it. Another long-term treatment option is Anthralin, a synthetic tar-like substance.
Contact sensitization treatment is another option and involves creating inflammation at the scalp which helps with this condition. Immunosuppressant tablets such as methotrexate, azathioprine, or cyclosporine can be used in more severe cases.
There also some new treatments, currently under clinical trials (tofacitinib, ruxolitinib, and baricitinib). These are potentially new immunosuppressive tablets for alopecia areata. Furthermore, topical formulations of these medicines are also being studied for their effectiveness in treating alopecia areata
Alopecia areata prognosis
Even in the most severe cases of alopecia totalis and alopecia Universalis, recovery may occur at some future date. According to research, 40% of patients with one bald patch have full hair regrowth within 6 months and 27% of patients with multiple patches of hair loss have full regrowth within a year.
Important factors to consider
Your hair is not just decoration for your head – it is also protection. If you have bald patches remember to use sunblock or a hat to prevent sunburn in strong sunlight. And watch out for low doors, cupboards, and tree branches that can cause nasty scrapes on your bare scalp.
Alopecia areata facts
This skin condition is probably the third most common form of hair loss dermatologists see, and the lifetime risk is two in every 100 people at some point in their lives. It is not contagious and can affect men, women, and children. If you have alopecia areata you are slightly more likely to get other autoimmune conditions like vitiligo, lupus, diabetes, ulcerative colitis, and thyroid disease.
A total cover-up
If you feel self-conscious about your hair loss and are finding that regrowth is taking too long, wearing a wig or hairpiece is always an option. You can find one privately, or ask your consultant to prescribe you one through the NHS (there is some cost involved to you). Your hospital orthotic department will recommend suppliers who are good at assisting people with alopecia areata.
What else can I do?
Hair extensions can help to camouflage the problem, so look for a hairdresser who specializes in this. It is important to avoid too much tension on any hair when this is done because this in turn could cause hair loss, known as traction alopecia. Artificial eyelashes, eyebrow pencils, and eyebrow tattoos can also help you feel better about your appearance.