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Alopecia Areata Hair Loss

Recently I have been receiving emails asking questions about Alopecia Areata.  In the past I have written articles about AA and of course in the early days of HairBoutique.com we consulted with several hair loss experts.

I decided to do a refresher course to see what information had changed or expanded with AA, which is a puzzling hair loss condition.

What Is Alopecia Areata?

Alopecia areata (AA) is a condition affecting humans, in which hair is lost from some or all areas of the body, usually from the scalp.

Because it causes bald spots on the scalp, which can occur suddenly without any warning, especially in the first stages, it is sometimes called spot baldness.

In 1%-2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis).   Conditions resembling AA, and having a similar cause, occur also in other species.

Types Of Alopecia Areata Hair Loss

The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.

- Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.

- Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.

- Alopecia areata multilocularis refers to multiple areas of hair loss.

- The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.  If the AA patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.

- If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.

Alopecia areata totalis and universalis are rare.

Causes

Alopecia areata is noncommunicable, or not contagious. It occurs more frequently in people who have affected family members, suggesting that heredity may be a factor.

Strong evidence that genes may increase risk for alopecia areata was found by studying families with two or more affected members.

This study identified at least four regions in the genome that are likely to contain alopecia areata genes. In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.

The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth.

There is evidence that T cell lymphocytes cluster around these follicles, causing inflammation and subsequent hair loss. An unknown environmental trigger such as emotional stress or a pathogen is thought to combine with hereditary factors to cause the condition.

There are a few recorded cases of babies being born with congenital alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system.

Diagnosis

First symptoms of Alopecia Areata (AA) are small, soft, bald patches which can take just about any shape but are most usually round.

It most often affects the scalp and beard but may occur on any hair-bearing part of the body. There may be different skin areas with hair loss and regrowth in the same body at the same time. It may also go into remission for a time, or permanently.

The area of hair loss may tingle or be very slightly painful.

The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.

Another presentation of the condition are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance.

One diagnostic technique applied by medical professionals is to gently tug at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair.

In healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp.

In cases of alopecia areata hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.

Professionals usually remind patients that the hair that is pulled out would eventually fall naturally. The test is conducted only once to identify the condition and rule out a simple localized hair loss condition.

Nails may have pitting or trachyonychia.

Treatment

About 50% of patients' hair will regrow in one year without any treatment. If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. In 90% of cases, the hair will, ultimately, grow back. In the other 10%, only some or no hair will regrow.

In cases where there is severe hair loss, there has been limited success treating alopecia areata with clobetasol or fluocinonide, steroid injections, or cream.

Steroid injections are commonly used in sites where there are small areas of hair loss on the head or especially where eyebrow hair has been lost. Some other medications used are minoxidil, irritants (anthralin or topical coal tar), and topical immunotherapy cyclosporine, each of which are sometimes used in different combinations.

Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs have adverse side effects.

For small patches on the beard or head it is possible to suppress with topical tacrolimus ointments like Protopic. Symptoms may remain suppressed until aggravated by stress or other factors.  Treatment with tacrolimus is sometimes recommended only for short periods of time due to adverse side effects.

Initial stages may be kept from increasing by applying topical corticosteroids. However, topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.

In terms of adapting to the disease rather than treating in an effort to cure, there are also many options available. Wigs are often used by those with Alopecia, particularly Alopecia Totalis, in which hair is entirely lost from the scalp. Wigs are available at many levels of development and technology, including wigs with suction mechanisms to keep it firmly attached to the scalp. Most of the wigs available are so well made that it is impossible without close investigation to tell whether they are a person's actual hair, or a wig.

Prognosis

In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year.  In cases with a greater number of patches, hair can either grow back or progress to alopecia totalis or, in rare cases, universalis.

-Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies, atopic dermal ailments, and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun.

Loss of nasal hair increases severity of hay fever and similar allergic conditions. Patients may also have aberrant nail formation because keratin forms both hair and nails.

Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, however, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time.

Episodes of alopecia areata before puberty predispose chronic recurrence of the condition. Pitting of the fingernails can hint at a more severe or prolonged course.

Psychosocial issues

Alopecia can certainly be the cause of psychological stress. Because hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression.

Some psychologists have even gone as far as to describe the feelings of loss and depression felt at the onset of the disease as being similar to those felt by people afflicted with terminal illness. In severe cases where the chance of hair regrowth is slim, individuals need to adapt to the condition, rather than look for a cure.

More Information

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