Alopecia Areata Information

Alopecia is the medical term for hair loss. Areata means patchy. Alopecia areata is a condition that causes your hair to fall out in patches. This patchy hair loss can develop anywhere on the body and affects millions of people worldwide.

Alopecia Areata

Anyone can develop alopecia areata. Men and women get it equally, and it affects all racial and ethnic groups. The onset can be at any age, but most people get it in their teens, twenties, or thirties. When it occurs in children younger than age 10, it tends to be more extensive and progressive.

Causes of Alopecia Areata

Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss. The condition occurs when white blood cells attack the cells in hair follicles, causing inflammation and the hair follicles to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way.

While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.

Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy (a disorder characterized by a tendency to be hyperallergic), thyroiditis, and vitiligo.

Other possible risk factors that have been identified include environmental factors. According to a study that appeared in the Journal of the American Academy of Dermatology, alopecia areata only occurs in about half of instances in identical twins. This demonstrates that hair loss may eventually result from a confluence of the environment, genetics, and immune system. This environmental trigger may be brought on by an illness, an allergy, hormones, toxins, or any combination of these factors. The exact reason is unknown.

Certain treatable medical conditions have been associated with alopecia areata. These include thyroid disease, vitamin D deficiency, pernicious anaemia/vitamin B12 deficiency and iron deficiency.

Despite what many people think, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the condition, but most recent research points toward a genetic cause.

Symptoms of Alopecia Areata

The most prominent symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Any site of hair growth may be affected, though, including the beard and eyelashes.

The loss of hair can be sudden, developing in just a few days or over a period of a few weeks. There may be itching or burning in the area before hair loss. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment.

About 30 percent of individuals who develop alopecia areata find that their condition either becomes more extensive or becomes a continuous cycle of hair loss and regrowth. About half of patients recover from alopecia areata within 1 year, but many will experience more than one episode. Around 10 percent of people will go on to develop alopecia totalis or alopecia universalis. Alopecia totalis means that all the hair on the scalp is lost, so the scalp is completely bald. Alopecia universalis is when the person loses all hair, leaving the entire body hairless (this is rare).

Alopecia areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are a number of small changes that can occur to nails:

  • pinpoint dents appear
  • white spots and lines appear
  • nails become rough
  • nails lose their shine
  • nails become thin and split

Additional clinical signs include:

  • Exclamation mark hairs: This occurs when few short hairs that get narrower at their bottom and grow in or around the edges of bald spots.
  • Cadaver hairs: This is where hairs break before reaching the skin surface.
  • White hair: This may grow in areas affected by hair loss.

Diagnosis of Alopecia Areata

Doctors are usually able to diagnose alopecia areata fairly easily by examining symptoms. They might look at the degree of hair loss and examine hairs from affected areas under a microscope. A gentle pull test will show hair coming out easily from the affected area.

If, after an initial clinical examination, the doctor is not able to make a diagnosis, they can perform a skin biopsy. If they need to rule out other autoimmune diseases, they might perform a blood test. As the symptoms of alopecia areata are so distinctive, making a diagnosis is usually quick and straightforward.

Treatment of Alopecia Areata

There is currently no cure for alopecia areata, although there are some forms of treatment that can be suggested by doctors to help the hair re-grow more quickly. The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. It’s also important to remember that treatment isn’t always successful. Some people may continue to have hair loss, even with treatment.

The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These are most commonly administered through local injections, topical ointment application, or orally.

Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil and oral or topical immunosuppressants. 

Blood therapy has also shown promising responses in stimulating hair growth in alopecia areata. This treatment involves injecting the patient’s own platelet-rich plasma into the affected area, which contains growth factors important for cell proliferation and differentiation and has anti-inflammatory properties.

Recent case reports have suggested that metformin may have more benefits than treating diabetes. Scientists are exploring if the anti-inflammatory properties of topical metformin will be beneficial as a treatment option for autoimmune hair loss conditions.

Some people with alopecia areata choose alternative therapies to treat the condition. However, it’s important to know that these are all experimental. They have not been tested in clinical trials, and there is no solid medical or scientific evidence to show that they’re effective. 

Natural and alternative treatments include acupuncture, aromatherapy, vitamins and supplements (including zinc and biotin), essential oils and other oils (such as coconut, tea tree, and castor oil), onion juice rubbed onto the scalp, and probiotics.

In addition to its aesthetic aspect, hair affords a degree of protection against the elements. People with alopecia areata who miss the protective qualities of hair may wish to:

  • Wear sunscreen if exposed to the sun.
  • Wear wraparound glasses to protect the eyes from the sun and debris which the eyebrows and eyelashes would normally defend against.
  • Use headwear such as hats, wigs, and scarves to protect the head from the sun or keep it warm.
  • Use ointment inside the nose to keep membranes moist and to protect against organisms that are normally trapped by nostril hair.

Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.

Support groups and counselling are available for people to share their thoughts and feelings, and to discuss common psychological reactions to the condition.

The effectiveness of each treatment will vary from person to person. Some people won’t need treatment because their hair grows back on its own. However, in other cases, people won’t see improvement despite potentially trying every treatment option.

You might need to try more than one treatment to see a difference. Keep in mind that hair regrowth may only be temporary. It’s possible for the hair to grow back and then fall out again.

Take home message

Because hair loss can greatly affect a person’s quality of life, researchers continue to study alopecia areata. Much of this research focuses on developing more effective treatments. This is giving new hope to patients, especially those living with widespread hair loss.

The prognosis for alopecia areata is different for each person, it’s also unpredictable. Once you develop this autoimmune condition, you may experience lifelong bouts of hair loss and other related symptoms. However, some people may only experience hair loss once in their lifetime.

The same variation applies to recovery – some people may experience full regrowth of hair, while others may not. They may even experience additional hair loss.

Alopecia areata isn’t usually a serious medical condition, but it can cause a lot of anxiety and sadness. Support groups are out there to help you deal with the psychological effects of the condition.

If you lose all your hair, it could grow back. If it doesn’t, there are different ways to cover your hair loss and protect your scalp. If you notice sudden hair loss, always check with a doctor. There can be other reasons for it besides alopecia areata.