Alopecia areata is a common cause of non-scarring hair loss. It can be effectively treated in most cases with simple anti-inflammatory injections. Our dermatologists are experts in the management of all forms of hair loss. Regrowth can be expected in over 90% of cases.
- This is one of the most common hair loss disorders
- It often presents as a small area of focal hair loss known as alopecia
- Scalp hair is mostly affected, followed by beard, eyebrow & lashes
- Alopecia can occur in children & adults
- Most cases can be treated with simple treatments
- Dermatologists can manage all cases including complex alopecia areata
Alopecia Areata at a glance
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Alopecia areata has several different patterns. Alopecia areata has different classifications and types like:
Patchy alopecia areata:
- The most common type and the main characteristic of this type of alopecia areata is one or more coin-sized patches of hair loss on the skin or body. The patches can expand and become alopecia totalis or alopecia universalis.
- Alopecia totalis happens when you have hair loss across the whole scalp. Up to 5% of autoimmune hair loss is affected by alopecia totalis.
- Along with losing hair on the scalp, people with this type of alopecia areata also lose all hair on the face, eyebrows, and eyelashes. It can also lead to loss of other body hair, including chest, back, and pubic hair. Alopecia universalis happens rarely and affects less than 1% of the cases of autoimmune hair loss.
Diffuse alopecia areata:
- It results in sudden and unexpected thinning of hair all over the scalp, not in just one area or patch. The Persisting new growing hair tends to grey, thus descriptions of ‘turning white overnight’. It can also be confused with other clinical conditions.
- It is a type of alopecia areata that affects the back and the lateral of the scalp. The bald area can then encircle the scalp.
Alopecia areata of the nails:
Alopecia areata in nails affects 10–50% of those who have alopecia areata. It can cause pitting, which are tiny depressions on the nails, and ridging.
Alopecia Areata is an autoimmune disease where your body attacks hair follicles causing hair loss. The hair loss happens suddenly in round non-scarring patches which can affect the hair follicle in different parts other than the scalp like beard, eyelashes, eyebrows, as well as other parts of the body.
No. Alopecia areata doesn’t destroy the hair follicle itself, but the autoimmune-induced inflammatory response causes damage to the resulting hair which gives the possibility of hair regrowth and this also differentiates this disease from other similar conditions.
The condition can extend to hair loss of the whole body (alopecia universalis) or cause hair loss throughout the entire scalp (alopecia totalis). The hair regrowth can happen slowly, but it’s not guaranteed, and the hair may fall off again. The degree of hair loss and regrowth varies from person to person.
Alopecia Areata is an autoimmune condition, where the immune system, which is normally the natural defense that protects the body from infections and other diseases, triggers an inflammatory response against the growing hair.
The main cause is unknown; however, some triggers can contribute to it:
- Viral infection
- Hormonal changes
- Emotional/physical stressors
- Previous history of other autoimmune conditions like rheumatoid arthritis or type 1 diabetes
- Family history of Alopecia Areata: about 20% of the cases
The main symptom of alopecia areata is hair loss which usually happens in small patches at first. The hair loss is symptomless in most of the patients, but some feel a tingling sensation when the patches start losing hair.
Unlike tinea infections, the skin is not inflamed & there is no scale with alopecia areata.
- A dermatologist diagnoses alopecia areata through examining the patches where hair loss is found, taking medical and family history, and performing some in-consultation tests such as the hair-pull test which is a simple test to measure the severity of hair loss.
- Alopecia areata also has a characteristic sign called Exclamation mark hairs that are 2 to 3 mm in length, broken or tapered, with a club-shaped root. The dermatologist may also do a biopsy to exclude other conditions that cause hair loss and perform blood tests if other autoimmune diseases are suspected.
- Dermatologists also use trichoscopy (use of a dermatoscope to examine hair and scalp) to confirm the diagnosis.
Alopecia areata may resolve by itself. In most cases, the hair regrowth happens spontaneously. Dermatologist may hasten regrowth with topical & intralesional anti-inflammatory medications, which most of which are different forms of steroids.
Treatment options include:
1- Topical agents: treatment applied on the affected areas to stimulate hair growth:
- Minoxidil: act as a hair growth stimulant for cases with limited alopecia areata. Applied twice daily and needs a long period to show results. Minoxidil is also found in both foam and topical solutions.
- Anthralin: a drug that acts by creating inflammation by generating free radicals, which have antiproliferative and immunosuppressive actions.
- Topical Steroids: decrease the inflammation of the hair follicle and are found as creams, ointment, foams, and lotions.
- Steroids injections: it is for mild cases and injected to the affected area. Tiny needles inject the steroid and treatment has to be repeated every one to two months to regrow hair.
The injection doesn’t prevent new hair loss from occurring.
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Our doctors at Cutis Dermatology are one of Australia’s most experienced in the field of alopecia areata. We have helped thousands of patients regrow their hair- even in cases of total hair loss, or alopecia totalis.
Systemic oral drugs may be prescribed by your dermatologist in the following cases-
- More than 20% of scalp hair loss
- Rapid hair loss
- Chronic hair loss
- Severe distress
Drugs used are:
- Corticosteroids: decrease the inflammation but causes a lot of adverse effects and are difficult to use in the long term.
- Janus kinase (JAK) inhibitors (like tofacitinib and rituximab): a new approach to alopecia areata is to use immunosuppressors to modulate the autoimmunity causing the disease. The drugs were effective in some cases, but it still rarely used due to their side effects.
The remedies don’t quite treat alopecia areata, but they help decrease the stress and the inflammation caused by it. The remedies can be:
- Vitamins, like zinc and biotin
- Aloe vera drinks and topical gels
- Essential oils like tea tree, rosemary, lavender, and peppermint, other oils, like coconut, castor, olive, and jojoba
- An “anti-inflammatory” diet, also known as the “autoimmune protocol,” which is a restrictive diet that mainly includes meats and vegetables
- Scalp massage
- Herbal supplements, such as ginseng, green tea, Chinese hibiscus, and saw palmetto
The effectiveness of each treatment can be different from person to person. Some people won’t need treatment because their hair grows back on its own spontaneously.
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.
Since most autoimmune conditions can’t be predicted, alopecia areata can persist or go away by itself. When it becomes a long-term problem, patients may need some psychological help like counseling as they may develop anxiety, depression, and loss of self-confidence.
- Gender: Alopecia areata occurs in both men and women but Females are more likely to develop alopecia areata than males, but it’s not clear why. Where men experience hair loss more significantly than women.
- Age group: Alopecia areata starts in childhood in about 50%, and before the age of 40 years in 80%. Lifetime risk is 1–2% and is independent of ethnicity.
- There is an increased prevalence in patients with chromosomal disorders such as Down syndrome.
- Can be drug-induced with patients on biologic medicines.
- The prognosis of alopecia areata can be different for each person, due to the unpredictable state of autoimmune diseases, some people recover after just one exposure and others may experience it for the long term.
- The same variation applies to recovery: Some people will experience full regrowth of hair. Others may not. They may even experience additional hair loss.
- 40% of patients with a single patch of hair loss have full hair regrowth within 6 months.
- 27% of patients with multiple patches of hair loss have full regrowth within 12 months.
- 33% of patients with alopecia areata have chronic hair loss.
- There are also some factors that give a poor prognosis to alopecia areata cases like:
- early age of onset
- Extensive hair loss
- Nail changes
- Family history
- Having multiple autoimmune conditions.
Unfortunately, alopecia areata, like many autoimmune diseases, is sudden and can’t be predicted or prevented. The good news is that that in most cases, this condition can be effectively managed.