Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss. It affects roughly 6.8 million people in the United States and 147 million worldwide.
The estimated prevalence is approximately 1 in 1000 people, with a lifetime risk of approximately 2%.
In the majority of cases, hair falls out in small patches around the size of a quarter. For most people, the hair loss is nothing more than a few patches, though in some cases it can be more extreme.
Sometimes, it can lead to the complete loss of hair on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia universalis).
The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30.
- Alopecia areata is occasionally associated with other medical problems.
- Most often these bald areas regrow their hair spontaneously.
- Alopecia areata is rare before 3 years of age.
- There seems to be a significant inherited predisposition for the development of alopecia areata.
Symptoms of Alopecia areata
- Typical first symptoms of alopecia areata are small bald patches.
- The underlying skin is unscarred and looks superficially normal.
- These patches can take many shapes but they are usually round or oval.
- Alopecia areata most often affects the scalp and beard but may occur on any part of the body with hair.
- Different areas of the skin may exhibit hair loss and regrowth at the same time.
- The disease may also go into remission for a time or may be permanent.
- It is common in children.
- The area of hair loss may tingle or be painful.
- The hair tends to fall out over a short period of time.
- The loss commonly occurring more on one side of the scalp than the other.
- Exclamation point hairs, narrower along the length of the strand closer to the base, producing a characteristic “exclamation point” appearance, are often present. These hairs are very short (3–4 mm) and can be seen surrounding the bald patches.
- When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata, the 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.
- Nails may have pitting or trachyonychia.
Causes of Alopecia areata
- Systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth.
- T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss.
- It has been suggested that hair follicles in a normal state are kept secure from the immune system, a phenomenon called immune privilege.
- A few cases of babies being born with congenital alopecia areata have been reported.
- Alopecia areata is not contagious.
- It occurs more frequently in people who have affected family members, suggesting heredity may be a factor.
- Endogenous retinoids metabolic defect is a key part of the pathogenesis of the alopecia areata.
Alopecia areata Diagnosis
- Alopecia areata is usually diagnosed based on clinical features.
- Trichoscopy may aid in establishing the diagnosis. In alopecia areata, trichoscopy shows regularly distributed “yellow dots” (hyperkeratotic plugs), small exclamation-mark hairs, and “black dots” (destroyed hairs in the hair follicle opening).
- Areas of hair loss surrounded by exclamation mark hairs is sufficient for clinical diagnosis of alopecia areata.
- Reddening of the skin, called erythema, may also be present in the balding area.
- A biopsy is rarely needed to make the diagnosis or aid in the management of alopecia areata.
- Histologic findings may include peribulbar lymphocytic infiltration resembling a “swarm of bees”, a shift in the anagen-to-telogen ratio towards telogen, and dilated follicular infundibula.
- Other helpful findings can include pigment incontinence in the hair bulb and follicular stelae. Occasionally, in inactive alopecia areata, no inflammatory infiltrates are found.
Alopecia areata classification
Commonly, alopecia areata involves hair loss in one or more round spots on the scalp.
- Diffuse alopecia areata: Hair may also be lost more diffusely over the whole scalp.
- 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.
- Ophiasis alopecia areata refers to hair loss in the shape of a wave at the circumference of the head.
- Barbae Alopecia Areata: The disease may be limited only to the beard.
- Totalis Alopecia Areata: The person loses all the hair on the scalp.
- Alopecia Areata Universalis: If all body hair, including pubic hair, is lost, the diagnosis then becomes alopecia areata Universalis.
totalis and universalis are rare.
Can Alopecia areata be cured?
Alopecia areata can’t be cured. But it can be treated and hair can grow back. If you have it.
How to treat Alopecia areata?
Topical treatment for Alopecia areata
You can rub medications into your scalp to help stimulate hair growth. A number of medications are available, both over-the-counter (OTC) and by prescription.
These are anti-inflammatory drugs that are prescribed for autoimmune diseases. They can be given as an injection into the scalp or other areas. They can also be given in pill form or rubbed on the skin as an ointment, cream, or foam. The downside is that it may take a long time to work.
This is used when there’s a lot of hair loss, or if it happens more than once. Chemicals are applied to the scalp to produce an allergic reaction. If it works, this reaction is actually what makes the hair grow back. It also causes an itchy rash and usually has to be repeated several times to keep the new hair growth.
This treatment, which is put on the scalp, is already used for pattern baldness. It usually takes about 12 weeks before you see growth, and some users are disappointed in the results.
Other treatments for alopecia areata
include medications that are sometimes used for other autoimmune disorders. These medicines have differing amounts of success in re-growing hair.
Steroid injections are a common option for mild, patchy alopecia to help hair grow back on bald spots. Tiny needles inject the steroid into the bare skin of the affected areas.
The treatment has to be repeated every one to two months to regrow hair. It doesn’t prevent new hair loss from occurring.
Cortisone tablets: sometimes used for extensive alopecia, but due to the possibility of side effects, you should discuss this option with a doctor.
Immunosuppressants: like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma.
Light therapy is also called photochemotherapy or phototherapy. It’s a type of radiation treatment that uses a combination of an oral medication called psoralens and UV light.
Alopecia areata natural treatment
Some people with alopecia areata choose alternative therapies to treat the condition.
Essential oil treatment
Essential oil therapy or aroma therapy is a holistic healing treatment that uses natural plant extracts to promote health and well-being. Aromatherapy uses aromatic essential oils medicinally to improve the health of the body, mind, and spirit. It enhances both physical and emotional health.
Acupuncture is an ancient Chinese medicine-based approach to treating a variety of conditions by triggering specific points on the skin with needles.
Probiotics, which are a certain type of friendly bacteria, provide health benefits when eaten.
They are often taken as supplements that are supposed to colonize your gut with health-boosting microorganisms.
Probiotic foods include yogurt, kefir, sauerkraut, tempeh and kimchi.
Vitamin like zinc and biotin
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- aloe vera drinks and topical gels
- onion juice rubbed onto the scalp
- 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
Most of the alternative therapies are not clinically test.
Some lazer treatments also available
- FDA-cleared hair loss treatment and medical device for treating alopecia, receding hairline, balding & thinning hair to stimulate hair regrowth for men and women.
- Users can expect to see visible hair improvement in as little as 3 to 6 months.
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- Clinically proven FDA approved
- Recommended by physicians to grow thicker, fuller hair.
- The Ultima 9 Classic LaserComb targeted laser hair growth treatment delivers nourishing and therapeutic laser light energy directly to hair follicles to reverse hair thinning and promote hair growth and hair regrowth.
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- Fastest treatment times – as little as 11 minutes, every other day compared to other laser comb products.