Written by: Lucky Annem
Medically reviewed by: Dr. Lohi Pratti
Alopecia areata is a disorder where the body’s immune system attacks hair follicles. A hair follicle is an opening on the skin through which hair grows. This disease leads to hair loss mostly on the head and face, though it can affect other areas. The unpredictability of alopecia areata has its own implications during treatment and recovery. Though alopecia areata does not cause pain, it may be detrimental to emotional and mental health. There are some modern methods to potentially stimulate the regrowth of hair that may aid in alopecia recovery.
Before we dive into the specifics of alopecia, it is important to understand the broad category it falls under: autoimmune diseases. An autoimmune disease is a condition in which the immune system attacks its own body. The immune system is the body’s defense mechanism, sending white blood cells in order to protect from pathogens. This means that the immune system has to be able to differentiate foreign substances from the body’s natural cells. In an autoimmune disorder, the body fails to make this distinction and releases autoantibodies, a type of protein, to attack healthy cells. With alopecia areata, the body’s white blood cells attack healthy hair follicles, inhibiting the production of hair. The most common trigger for alopecia is mental or physical stress. Other triggers include herpes zoster, thyroid disorders, certain vaccinations, drugs like antiepileptics and anti-tuberculosis drugs, as well as monoclonal antibodies.
A main characteristic of alopecia areata is the sudden loss of rounded patches of hair on the scalp. Around these patches can be short, broken hairs. The progression of alopecia is difficult to predict; many different things can occur, including regrowth, development of more patches, aggregation of small patches to form larger ones, and even complete hair loss.
Alopecia areata comes in multiple forms: patchy alopecia areata, alopecia totalis, and alopecia universalis. Patchy alopecia areata is the most common. With this subtype, hair loss occurs in coin-like patches, often on the scalp. Alopecia totalis where all scalp hair is lost. There is another type of alopecia in which there is a sudden ‘overnight greying’ of hair as the pigmented hairs are lost. Lastly, alopecia universalis occurs when there is a complete loss of hair in places all over the body.
Alopecia areata is not confined to one group of people. It tends to affect individuals in their
teenage ages, twenties, and thirties; however, if diagnosed younger, there is a higher likelihood of the disease’s progression. The younger the onset of disease, the more there is the risk of alopecia universalis. There is also an association with atopic dermatitis can have an early onset and severe alopecia areata. Being an autoimmune disorder, alopecia areata can be associated with other diseases like SLE, vitiligo, rheumatoid arthritis, and inflammatory bowel syndrome. The cause of alopecia areata is not definite, but genetics, other autoimmune disorders, and stress may contribute to an increased likelihood of being diagnosed.
Diagnosis of alopecia areata involves examination, and a dermatologist searching for features of the disorder, like certain hair patterns. examine for particular symptoms including certain hair patterns. Nail changes can be seen in 10-15% of the cases, so many derms look for signs of rough nails when diagnosing. Physicians may use a microscope to observe follicle openings to gain further insight into if a patient is experiencing alopecia areata. If a diagnosis cannot be made, a skin biopsy may be used to deny or confirm the presence of the disorder.
Currently, there is no cure for alopecia areata. Unfortunately, this is the case for many autoimmune conditions. However, there are some treatment methods that may be effective. Many treatment plans involve suppressing the hyperactivity of the immune system while stimulating hair production. A consultation with a doctor is the best way to learn about possible treatments.
Here are some common treatment methodologies:
-Intralesional corticosteroid injections targeting bare patches of skin. Though these injections do not solve the root problem, they help to stimulate hair growth.
-Topical minoxidil in combination with topical corticosteroids. Topical corticosteroids are intended to decrease inflammation around the hair follicle. They come in many forms: lotions, ointments, solutions, foams, and creams.
Research is being conducted for alopecia areata into novel treatments. For instance, the use of immunomodulators, such as JAK (Janus kinase) inhibitors, is a new treatment being tested for alopecia areata.
When discussing alopecia areata, it is very important not to avoid the emotional effects caused by this condition. For many, it may affect their quality of life and self-esteem. If you or someone you know are in need of coping resources, visit National Alopecia Areata Foundation.
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