Alopecia Areata

Hair Treatments
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What is Alopecia areata

  • Alopecia means loss of hair. Alopecia areata is a type of localised hair loss which is typically seen as bald patches.
  • It may affect any hairy area of the body. It affect males and females equally.
  • In majority of cases hair regrows after several months.
  • It does not affect the general health of the person.

What are the causes of Alopecia areata?

  • Alopecia areata is considered to be an autoimmune disease. This occur when the body’s own immune system damages its healthy cells.
  • In Alopecia areata, white blood cells gather around the affected hair roots(hair follicle). This causes inflammation which leads to hair loss.
  • Genetics, atopy and environmental factors play a role.
  • It is not a hereditary condition.

How does Alopecia areata manifest?

  • It typically occurs as one or more bald patches on the scalp.
  • It can affect any hairy area of body. Hair loss may be seen on the scalp, beard, moustache,eyebrows, eyelashes or body hair may also be lost.
  • Scalp is the most common site affected in 90% of the cases. Apart from the bald patches, the scalp usually looks healthy and there is no scarring.
  • The bald patches are round in shape and the size of a coin.
  • The nails may be affected in about 1 in 10 cases of alopecia areata; there may be pitting or ridging on the nails.

What is the course of the disease?

  • It difficult to predict the progress of a bald patch of alopecia areata.
  • Usually the hair regrows within a few months. Initially it is grey or white in colour and normal colour returns after several months.
  • At times, one or more bald patches develop a few weeks after the first one. Large bald patches can also develop.
  • Sometimes, the entire scalp hair is lost. This is called alopecia totalis.
  • In a small number of cases, all scalp hair, body hair, beard, eyebrows and eyelashes are lost. This is called alopecia universalis.

FAQ on Alopecia Areata

  • Consult a dermatologist since it can be easily diagnosed by the dermatologist by the clinical appearance of the lesion.
  • Appropriate counseling, topical therapy and medications will be recommended by the dermatologist as per needs.
  • Usually no tests are required. The diagnosis is usually confirmed by clinical examination and it is based on the typical appearance of the bald patches. A dermatoscopy may aid the clinical diagnosis.
  • Blood test may be advised to check for other autoimmune diseases and a skin scraping or biopsy may be done to rule out other cause of hair loss.
  • Alopecia areata is a very unpredictable condition. In many cases, bald patches regrow by themselves without treatment. If the hair loss become more extensive hen the decision on whether to treat may be considered.

Steroid injections:

  • Injection of steroid (triamcinalone acetonide) in to the bald patches of the scalp of the scalp suppress the local immune reaction that occur in alopecia areata and allows the regrowth. This treatment may be an option for oe or more small to medium size bald patches.
  • This treatment is should only done by a skin specialist.
  • Large bald area are not suitable for steroid injections.
  • Injection are repeated every 4-6 weeks.
  • It takes 1-2 months for the hair to start to regrow.
  • There is no guarantee that any hair re-grown during treatment will persist.

                 Topical steroids and immunomodulators:

  • Steroid cream , gel, etc. can be used but these are not as effective as steroid injections. Topical steroids are to be strictly used under medical supervision and prolonged use should be avoided.

                Topical minoxidil solution:

  • Applied to the bald patches and has been shown to promote hair re-growth in some cases.

                 Contact immunotherapy:

  • Topical immunotherapy is the most effective option for people with extensive alopecia areata.
  • Substances like diphenylcyclopropenone(DPCP) is applied on affected skin to make the skin react like an allergy or dermatitis (eczema). The skin reaction affect the process involved in causing alopecia areata to regrow hair.

                Other treatment:

  • Phototherapy- either PUVA or UVB NBT
  • Immunosuppressive treatment- systemic steroids, cyclosporine, azathioprine or methotrexate.
  • Wigs are considered in resistant cases.
  • Tattooing can be considered in case of eyebrow hair loss for cosmetic reason.

Progression to extensive involvement is common if:

  • The bald patches start in childhood.
  • If there is history of atopic eczema.
  • If there is family history of alopecia areata.
  • The initial bout of hair loss affects more than half of scalp.
  • When eyelashes or eyebrows are involved.
  • Hair loss is around the scalp margin.
  • Nail changes are present.
  • Underlying autoimmune disease like vitiligo, lichen planus, thyroid disorder or diabetes may be present.
  • Spontaneous regrowth is usually seen in 80% cases, without treatment within a few months to a year.
  • However the course of the disease is unpredictable nd recurrence may occur in few cases.
  • Alopecia areata is a cosmetic problem. The change in appearance may cause anxiety, depression or feeling of unattractiveness. In children with alopecia areata, change in child behavior may be noted a the child may have low self-esteem and appear withdrawn.
  • Learn to develop positive feedback mechanismand accept the change in appearance.
  • Consult a dermatologist for appropriate counselling and treatment.