The Alopecia areata is considered an autoimmune disease whose origin is still unknown. It leads to hair loss by scalp plaques. Can lead to total baldness (alopecia universalis) and even the loss of all body hair (alopecia totalis). The Alopecia areata is a common disease that accounts for 2% of dermatological consultations. It is a disease that can have serious psychological consequences.
- 1 Alopecia areata – general information
- 2 Alopecia areata left untreated
- 3 Alopecia areata local treatment
- 4 Alopecia areata general treatment
- 5 Alopecia areata diagnosis
- 6 Alopecia areata – People at risk
- 7 Alopecia areata evolution
- 8 What causes Alopecia Areata?
- 9 Alopecia areata symptoms
- 10 Stages of severity of alopecia areata
Alopecia areata – general information
The Alopecia areata is characterized by hair loss by non-scarring plaques with inflammation. In the case of Alopecia areata immune system cells (lymphocytes) are activated for a reason yet unexplained and are targeting the root of hair that is recognized as “foreign” by the body. Various hypotheses have been advanced to explain the induction of this mechanism. It was estimated that 1.7% of the population will develop an Alopecia areata during their lives. The Alopecia areata can occur at any age although it is more common among children and adolescents. There are recurrences in 80 to 70% of cases. Furthermore, this pathology is the cause of a physical disability or mental distress in adults as in children.
The Alopecia areata is a chronic inflammatory disease that affects the hair follicles, it causes hair loss. The Alopecia areata is a disease whose origin is unknown but probably related to an abnormality of immunity to familial genes. Alopecia areata plates are of variable size, mainly localized on the scalp. However, the plates of Alopecia areata may occur in the beard, eyebrows, eyelashes or other hairy areas of the body. Alopecia areata plates extend to the periphery and may meet to form large areas of alopecia. At Alopecia areata plates, the skin is smooth, white, and the openings of hair are sometimes dilated. When Alopecia areata is evolutionary, the hair is easily detached at the edge of the plate.
The alopecia areata plate often heals on its own after several months of evolution even without any treatment, but relapses are frequent. Various treatments can regrow hair sometimes lasting even during severe alopecia areata. These treatments are not yet able to offer a cure.
In general people with Alopecia Areata are in good general health with no other symptoms but a number of epidemiological studies have shown in patients with alopecia areata greater frequency of autoimmune diseases (ie diseases where the body is attacking its own structures). However there is probably there is no link between these diseases. In addition associations with these diseases have been reported: Addison, lupus erythematosus, rheumatoid arthritis, scleroderma, pernicious anemia, pemphigus vulgaris, celiac disease, ulcerative colitis, juvenile diabetes. According to studies 10 to 60% of people have abnormal nails such as striations, cracks, dots, and red sandstone. These anomalies can be detected before the onset of Alopecia areata as after its regression.
Alopecia areata left untreated
Alopecia areata left untreated is without doubt the best alternative for alopecia areata in small patches of moderate size, they often heal without treatment after several months of evolution. Treatment is not useful when the patient is not hampered by his affection. We must also abandon the treatment when the hair follicles have disappeared and no longer grow.
Alopecia areata local treatment
- Local Corticoids – This treatment lasts several weeks and can be coupled to minoxidil. It can cause a thinning of the skin and small buttons that look like acne.
- Intralesional corticosteroid injections – It is indicated for the adult alopecia areata if the surface is not too large. The dermatologist performs superficial injections in the affected areas.
- Injections are repeated every month for approximately 3 to 6 months. It may be against use in case of hypertension, diabetes or infection. It may cause temporary thinning of the skin and development of small vessels.
- Minoxidil – It is a useful complement to regrow hair. It is often prescribed with local corticosteroids and anthralin.
- Anthralin – The anthralin is an effective product whose use is not very easy because it is irritating and affects skin color. It is used in increasing concentrations for short durations (10 to 30 minutes). It is a treatment often offered to children when other therapies are inappropriate. This treatment should not be involved in the UVA therapy.
- Immunotherapy contact diphencyprone (DCP) – It is a benchmark treatment whose effectiveness is proven by several studies of quality, it is reserved for severe alopecia areata. The diphencyprone (DCP) is a chemical drug which has no allergenic status. This treatment is only available in some centers, it requires an application weekly or biweekly for several months. This treatment requires a detailed patient information because it has side effects (eczema) and complications (depigmentation of the skin) that have not been evaluated by studies on a large scale.
Alopecia areata general treatment
- Corticoids by general treatment – Cortisone by general treatment is used during the course of severe outbreaks of the disease because it often allows to stop the hair fall until other treatments take over. The requirement of large doses in short courses gives good results in targeted indications.
- UVA therapy – The effectiveness of ultraviolet rays coupled with a photo sensitizer is an ancient treatment that may give good results. This treatment often requires several sessions (30 to 50) before hair regrowth occurs. Exposure of the whole body is necessary. The UVA therapy involves risk of skin cancer. The use of excimer laser is promising.
- Methotrexate – A recent study shows very good results of this therapy which has long been used in the treatment of psoriasis. It is a powerful treatment that is recommended in severe alopecia areata. Methotrexate endorsed by cortisone systemically in low doses is recommended.
- Cyclosporine A – This treatment has a strong suspension and side effects.
Alopecia areata diagnosis
Diagnosis of Alopecia areata is usually easier when the disease is manifested by recurrent alopecia plaques that heal and recurrences after a few months or years. Similarly, forms of total or universal alopecia areata generally pose no problem to dermatologists that are familiar with this condition. Careful examination with a magnifying device (or dermatoscope videomicroscope) allows the dermatologist to highlight hair during outbreaks of acute alopecia areata. The observation of the scalp can also view short hair whose end is broken and damaged hair to the root of the scalp. The dermatologist may request a blood test to look for auto immune diseases associated with alopecia areata.
Alopecia areata – People at risk
People who have a close relative suffering from Alopecia Areata. This would be one in five people suffering from Alopecia Areata.
Individuals with a family member who suffers from asthma, hay fever, atopic eczema or another autoimmune disease such as autoimmune thyroiditis, type 1 diabetes, rheumatoid arthritis , lupus, vitiligo or pernicious anemia.
Given that knowledge about the causes of Alopecia areata are very limited, no risk factor has been discovered so far. There is no way to prevent the onset of Alopecia areata.
Alopecia areata evolution
The Alopecia areata is a chronic condition that often lasts several years, its evolution is unpredictable. Alopecia areata regrowth being often white, hair often takes several months before it can return to normal color. Alopecia areata generally worsens over the years and especially if the alopecia areata is more severe at the time of diagnosis.The long-term prognosis is worse when the alopecia areata starts in childhood and when it touches the edge of the hair.
Usually the alopecia areata remains localized to the scalp and is restricted to small patches bare. However, in its extensive form, it can grow and extend to the beard and the entire scalp. The Universal Alopecia areata (loss of all body hair) is very rare. The evolution of Alopecia areata is highly unpredictable. Moreover, there is no cure to overcome it. Nothing protects a relapse (which is very common).
The evolution of Alopecia areata is difficult to predict because the severity and progress vary from one individual to another. However in some individuals alopecia areata may evolve into a total loss of hair of the head: This is alopecia totalis, which is more common in young subjects. A minority lose all their hair and all body hair and Alopecia areata is generalized (Alopecia areata universalis).
There are also diffuse alopecia areata leading to a decrease in hair density uniformly throughout the scalp. Moreover, the increase is more or less rapid. Thus, when a devastating alopecia areata bursts, all hair can fall in 48 hours. In others the alopecia areata evolves slowly over decades. Some people find a variation in the amplitude of the alopecia areata depending on the season. Hair from different parts of the body can repel independently. During regrowth, the new hair is usually bleached at first, and then it will take the usual color and diameter.
What causes Alopecia Areata?
The exact factors responsible for the Alopecia areata is unknown. Considering that Alopecia areata is an autoimmune disorder (the body considers its own cells as foreign and tryes to eliminate them) which predominantly affects genetically predisposed subjects. There are isolated observations of hair loss after episodes of severe stress, but the most recent studies do not show psychological factor behind the alopecia areata, the Alopecia areata is not a illness “nervous”.
Scientists do not know what triggers hair loss. They assume that the mechanism involves destruction of hair as an autoimmune system reaction. Fortunately, stem cells of hair follicles are not affected by the disease, so the hair can regrow, even after several years of dormancy. Heredity and environmental factors (including viral infections, trauma, chemical or physical stress, etc..) could play a triggering role.
It is important to protect the skin, eyes and nose of the external factors :
- While protecting the skin from the sun, a good sunscreen may do the trick. For the head, you can opt for wearing a wig, a hat or a headband, which has the advantage of keeping the head cool.
- Wear safety goggles (or sunglasses) to protect the eyes from the sun and dust for those who have lost their eyebrows and eyelashes.
- In case of loss of nose hair, it may be useful to apply an antibiotic lotion into the nostrils to protect against micro-organisms that invade the nose and cause colds, flu, sinusitis, etc.. Ask the advice of a doctor.
Alopecia areata symptoms
- One or more plates completely denuded of hair. Occasionally, itching or burning sensation may be felt in the affected area, but the skin retains a normal appearance.
- Sometimes, nail abnormalities such as striations, cracks, spots and redness. The nails may become brittle.
- Exceptionally, a loss of all hair and.
The Alopecia areata starts abruptly at any age but most often in children or young adults, it evolves by episodes that can be repeated throughout life. The Alopecia areata is a hair loss, depilation of body hair. Alopecia areata in the small plates is the most common form. Alopecia areata plates have variable sizes and shapes. The diffuse Alopecia areata is rare, it results in an extensive hair loss that affects the entire scalp. The alopecia areata universalis is a total depilation of all body hair. Loss of eyelashes, eyebrows or nails abnormalities may be isolated but more often accompanies severe alopecia areata.
The seriousness of the alopecia areata is evaluated according to the capillary surface affected.
Stages of severity of alopecia areata
- No alopecia
- alopecia surface of less than 25% of the scalp
- alopecia surface between 25% and 49% of scalp
- alopecia surface between 75% and 99% of scalp
- Alopecia complete
The alopecia areata plates have a rounded shape, centrifugal, size varying between 2 and 8 cm in diameter at the end of evolution. In more than 50% of cases, hair will grow back all alone, between six months and one year after the first loss af hair. Unfortunately regrowth is random and it is essential to stimulate by appropriate treatment. Recurrences are frequent and unpredictable: in 50% of cases, they may reappear 5 or 10 years after the disappearance of the first area.
Much more rarely (5% of cases), Alopecia areata process may extend over the entire scalp; is called Total Alopecia Areata. Even more rarely (0.20% of cases), Alopecia areata is spreading throughout the hair and all body hair falls. This is known as alopecia areata universalis. Whether partial or total, the Alopecia areata affects both men and women, it affects particularly the brown hair and younger subjects (about 60% of cases occur before age 20). The average age is around 30 years.
Jessica earned a Bachelors Degree in Nutrition in University of Tennessee. She is currently a PhD Candidate at the Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney.
Jessica is a health and nutrition enthusiast. She is fitness and nutrition blogger.