Alopecia areata is a widespread autoimmune condition that often leads to impredictable loss of hair.
In the United States it affects about 6.8 million people.
For most cases, hair falls down to around a quarter size for small patches. In most people hair loss is nothing more than a few spots, but it can be more severe in some situations.
It may often lead to full hair loss on the scalp (alopecia totalalis) or, in extreme cases , the entire body (alopecia universalis).
The disorder may affect anyone irrespective of age and gender, but most cases occur before age 30.
We look at the causes and symptoms of alopecia areata, its diagnosis and potential treatments in this article.
Important facts about alopecia areata
Below are a few key points about alopecia areata. The main article includes more descriptions and supporting material.
- One in five people with alopecia areata also has a family member who has experienced the condition.
- Alopecia areata often develops suddenly, over the course of just a few days.
- There is little scientific evidence that alopecia areata is caused by stress.
- People with alopecia areata who have only a few patches of hair loss often experience a spontaneous, full recovery, without the need for treatment.
- There is no cure for alopecia areata.
There is currently no cure for alopecia areata although there are some forms of treatment that doctors can suggest to help hair re-grow faster.
The most common form of treatment of alopecia areata is the use of corticosteroids, potent anti-inflammatory drugs which can suppress the immune system. These are mostly administered by local injections, or by oral application of topical ointment.
Other medicines which can be prescribed either to encourage hair growth or to influence the immune system include Minoxidil, Anthralin, SADBE and DPCP. While some of these can help with hair re-growth, they can’t prevent new bald patches from developing.
Some reports support the use of photochemotherapy and offer a possible option for patients who are unable or reluctant to undergo conventional or invasive therapies.
Besides its aesthetic aspect, hair offers some degree of protection against the elements. People with alopecia areata who miss the hair’s protective qualities might want 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 specifically cause illness to people nor is it contagious. It can, however, be emotionally difficult to adapt. Alopecia areata is a traumatic disease for many people that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.
For people to share their thoughts and feelings, and to discuss common psychological reactions to the condition, support groups and counseling are available.
Some have compared alopecia areata to vitiligo, an autoimmune skin disease in which the body attacks melanin-producing cells which leads to white patches. Research indicates that these two diseases may share a similar pathogenesis, with similar forms of immune cells and cytokines driving the disease and common genetic risk factors.
As such any new developments in either disease’s treatment or prevention can have consequences for the other.
A handful of documented cases have occurred in which treatment for alopecia areata using diphencyprone (DCP), a contact sensitizer, has led to vitiligo developing.
Preliminary animal research has shown that quercetin, a naturally occurring bioflavonoid contained in fruits and vegetables, can protect against alopecia areata growth, and effectively treat established hair loss.
Further study, including human clinical trials, is required before quercetin can be regarded as a treatment for alopecia areata.
The condition occurs when the cells in hair follicles are attacked by white blood cells which cause them to shrink and dramatically slow hair production. Exactly what causes the body’s immune system to target hair follicles this way is unknown.
Although scientists are uncertain about why such changes occur, genetics tend to be involved, as alopecia areata is more likely to occur in a person with the disease having a close family member. One in five people with the disease has a member of the family, who also developed alopecia areata.
Many research has shown that many individuals with a family history of alopecia areata often have a personal or family history of other autoimmune disorders, such as atopy, a disease characterized by a tendency to be hyperallergic, thyroiditis, and vitiligo.
Despite what many people think, there is very little scientific evidence to back up the view that stress causes alopecia areata. Extreme stress cases may theoretically trigger the condition but recent research points to a genetic cause.
Since conventional alopecia treatments are extremely limited, studies on the ground which support natural alopecia treatments are even thinner.
Some people recommend rubbing onion or garlic juice into the scalp, cooled green tea, almond oil, rosemary oil, honey or coconut milk. Although none of these are likely to cause harm, work often lacks evidence for their effectiveness.
Some people resort to alternative forms of treatment, such as acupuncture and aromatherapy, but there is little, if any, evidence to support these treatments.
Patchy hair loss is the most common symptom of alopecia arata. Coin-sized hair patches start falling out, mostly from the scalp. However, any hair growth site, including the beard and the eyelashes, can be affected.
The hair loss can develop suddenly in just a few days, or over a period of a couple of weeks. Before hair loss there can be itching or burning in the area. The hair follicles are not damaged and so, if the follicle inflammation subsides, hair will re-grow. Those who suffer just a few patches of hair loss frequently get a spontaneous, complete recovery without any care.
Approximately 30 percent of people who develop alopecia areata find their condition either becoming more extensive or becoming a continuous cycle of hair loss and regrowth.
Approximately half of patients recover within 1 year from alopecia areata but others will experience more than one episode. Around 10 per cent of people will continue to develop total alopecia or universal alopecia.
Alopecia areata can also affect the fingernails and toenails, and these changes are sometimes the first sign that the condition develops. There are a variety of small changes that can happen to the 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.
Doctors are usually able to diagnose alopecia areata by examining symptoms fairly easily. They may be looking at the degree of hair loss and microscopically analyzing hairs from affected areas.
When the doctor is unable to make a diagnosis after an initial clinical examination, they can do a skin biopsy. They could do a blood test if they need to rule out certain autoimmune diseases.
As the symptoms of alopecia areata are so distinctive, it is usually quick and straightforward to make a diagnosis.