What is Alopecia Areata?
Alopecia Hair loss (aka Alopecia Areata) refers to a condition that can affect any hair bearing area and manifest in different forms. Although scalp hair is most commonly affected, you can get alopecia hair loss over your eyebrows, beard, eyelashes and arms. Alopecia tends to be a recurrent condition, and is associated with emotional and psychological distress.
Alopecia Areata is an uncommon condition, unlike Male and Female pattern hair loss, which are prevalent in the general population. Alopecia affects only up to 0.2% of the population at any given time. Alopecia is a condition that mainly starts in teenagers, and young adults, but can occur at any age from birth to the later decades of life. Men and women are equally likely to be afflicted with alopecia. While the exact reason why an individual gets alopecia is unknown, autoimmunity (where the body’s antibodies decides to attack the hair follicles), genetics, and hereditary factors may play a part.
An examination of your skin to determine if you are indeed having Alopecia Areata, or other hair loss conditions such as male pattern hair loss, infections such as fungal infections or psoriasis is the first step.
What does Alopecia look like?
It is not surprising for many of our patients to complain of a bald spot on their scalp after a visit to the hairdresser or barber. As alopecia areata is symptomless in the majority of patients, it may not be apparent until someone points it out to you. In some cases however, patients do experience an itching or burning sensation over the affected area.
Fortunately, most individuals with alopecia have only a single patch of hair loss, while up to 8% of alopecia sufferers have multiple patches of hair loss. There is no evidence to link multiple patches to the severity of alopecia down the road.
The alopecia area is round to oval in shape, and the area feels smooth. The bald area is usually normal skin colour, but may appear slightly red due to the underlying inflammatory process. The hair loss in alopecia can occur quite rapidly.
About half of individuals with alopecia may notice some pitting over the fingernails and/or toenails. Pitted nails present as small dents on the surface of the nails, and may indicate a more severe disease process.
How Is Alopecia Areata Diagnosed?
Alopecia areata is mostly diagnosed based on the clinical appearance. Quite often, it is first noticed by your hairdresser as it is mostly asymptomatic. It’s a non-scarring disease which means that the hair follicles are still present. When you look closely, you may be presence of white hairs within the patch as well as ‘exclamation mark’ shaped hairs. Exclamation hairs are broken off hairs that tapers towards the end and can be pulled out easily. This presence of these exclamation marks hairs indicates that the disease is active and more hair loss is to be expected in the coming weeks.
Causes of Alopecia Areata
While researchers have not yet established the exact cause of alopecia, it is generally believed that alopecia involves an abnormality in the body’s immune system in genetically susceptible individuals. This abnormal immune response (called Autoimmune disease) fools the body’s own antibodies into attacking the growing hair follicle. As a result the hair is shed and new hair is unable to grow normally. Genetic factors play an important role in alopecia; as much as 10-20% of alopecia sufferers have a positive family history of alopecia as well.
While alopecia is most likely due to an abnormality of the immune system, there are certain conditions that trigger off alopecia, and patients with certain medical conditions seem to be more susceptible to it:
- Atopic eczema
- Thyroid disease
- Down syndrome
- Psychiatric disorder such as Anxiety, depression
- Recent Stressful life event e.g. exams, divorce, death in the family
Alopecia is a benign hair loss condition, and does not cause any harm to your physical health. Alopecia is not known to be associated with medications, or the side effects of medications. However, suffering from alopecia areata can often cause distress, anxiety and depression.
Types of Alopecia Areata
There are different manifestations of alopecia. They are classified according to its pattern:
- Alopecia Areata – Most common type. Patchy hair loss, usually single patch on the scalp.
- Reticular- More severe pattern of hair loss, patches may join together.
- Ophiasis – Hair loss at sides and back of scalp
- Sisasipho (Ophiasis spelled backwards) – Hair loss sparing the sides and back of scalp
- Alopecia Totalis – Complete hair loss on scalp
- Alopecia Universalis – Complete hair loss on all hair bearing areas.
What Are Indicators Of Poor Prognosis?
- Onset of alopecia areata before the age of 12.
- Disease duration of more than 1 year
- Multiple discrete patches
- More than 50% scalp hair loss
- Ophiasis pattern of alopecia areata
- Associated nail disease e.g. pittinh
- Associated Atopy, Down’s syndrome, positive family history and presence of auto-immune diseases.
Alopecia Hair Loss Treatment
While alopecia areata can be a long-term condition in many individuals, but you will be happy to know that the majority of Alopecia Areata cases spontaneously revert back to normal within a year. While it may be a one off event for some, it can be a recurrent problem for others.
As a chronic disorder, there is no definitive cure for Alopecia Areata, however, there are alopecia hair loss treatment options to manage and alter the disease process and stimulate hair growth.
We will examine the involved area and work out a alopecia hair loss treatment plan according to the severity of the condition.
Alopecia Areata Treatment options include the following:
- Topical anti-inflammatory creams
- Minoxidil 5% solution
- Anthralin contact therapy (an irritant )
- Localized anti-inflammatory corticosteroid injections, Injections are administered every 4-6 weeks to stimulate hair growth.
- Contact immunotherapy
- Short term oral steroids in selected cases.
Most individuals will observe early hair growth from 4 weeks after your treatment.
There will be some initial pain and swelling for a few days after injection. Corticosteroids can lead to skin discolouration, skin and fat atrophy, and indentations.
As the behaviour of alopecia areata can unpredictable, repeated treatments may be necessary every 4-6 weeks.
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- Rajabi, F., Drake, L., Senna, M. and Rezaei, N. (2018), Alopecia areata: a review of disease pathogenesis. Br J Dermatol, 179: 1033-1048. https://doi.org/10.1111/bjd.16808
- Cranwell, W.C., Lai, V.W., Photiou, L., Meah, N., Wall, D., Rathnayake, D., Joseph, S., Chitreddy, V., Gunatheesan, S., Sindhu, K., Sharma, P., Green, J., Eisman, S., Yip, L., Jones, L. and Sinclair, R. (2019), Treatment of alopecia areata: An Australian expert consensus statement. Australas J Dermatol, 60: 163-170. https://doi.org/10.1111/ajd.12941