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Alopecia Areata Treatment
Are you experiencing patchy hair loss and wonder if it can be treated?
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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.
OUR APPROACH
HOW DR.NG TREATS alopecia areata
Alopecia Areata or alopecia hair loss can occur without warning. It can occur at any age, and may be triggered by certain factors such as stress, illness or disease. The aim of alopecia hair loss treatment is to reduce disease progression and to prevent hair loss. Hair loss that is progressive can affect your confidence. With over a decade of experience treating both male and female hair loss, Dr Ng. will help you diagnose and customise a treatment plan to help you restore and maintain your hair.
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. The presence of these exclamation marks hairs indicates that the disease is active and more hair loss is to be expected in the coming weeks.
What causes 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
- Vitiligo
- 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?
The course of alopecia areata is unpredictable. Some patients experience spontaneous regrowth of hair, while others may have recurrent episodes or chronic hair loss. Early intervention and ongoing management can help improve outcomes and enhance the quality of life for those affected. Factors associated with poor prognosis includes:
- 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 Areata Treatment Options
While there is no cure for alopecia areata, various treatments can help stimulate hair regrowth and manage the condition. Treatment choices depend on the extent of hair loss, patient age, and the disease’s impact on the patient. Common treatments include:
- Topical Corticosteroids: Applied directly to the affected areas to reduce inflammation and suppress the immune response.
- Intralesional Corticosteroids: Injections of corticosteroids into the bald patches, particularly effective for small, localized areas of hair loss.
- Topical Immunotherapy: Agents like diphenylcyclopropenone (DPCP) or squaric acid dibutylester (SADBE) applied to induce a mild allergic reaction and divert the immune response.
- Minoxidil: A topical solution that can promote hair growth in some patients.
- Oral Immunosuppressants: Medications such as methotrexate or cyclosporine may be used in severe cases, though potential side effects require careful monitoring.
- JAK Inhibitors: Emerging as a promising treatment option, drugs like tofacitinib and ruxolitinib have shown efficacy in clinical trials by targeting specific pathways in the immune response.
Frequently Asked Questions About Alopecia Areata
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.
No, alopecia areata is not contagious. It is an autoimmune condition and cannot be transmitted through contact with affected individuals.
There is currently no cure for alopecia areata, but various treatment options are available to help manage symptoms and promote hair regrowth. Treatment effectiveness varies from person to person, and some individuals may experience spontaneous regrowth without treatment.
Since the exact cause of alopecia areata is not fully understood, there are no known prevention strategies. However, maintaining overall health and managing stress levels may help support the immune system and possibly reduce the risk of flare-ups in some individuals.
The prognosis for alopecia areata varies widely. In some cases, hair may regrow spontaneously without treatment, while in others, the condition may persist or recur over time. Treatment can help manage symptoms and promote hair regrowth, but outcomes are not guaranteed, and relapses are possible. Working closely with a healthcare professional can help develop an individualized treatment plan and monitor progress over time.
alopecia areata Insights
Alopecia areata is a complex autoimmune disorder requiring a multidisciplinary approach for optimal management. Advances in understanding the pathophysiology of the disease have led to new treatment options, offering hope for better control and potential hair regrowth. Doctors play a critical role in diagnosing, treating, and supporting patients with alopecia areata, aiming to minimize its physical and psychological impact.
Schedule a consultation for alopecia areata treatment in Singapore
The first appearance of patchy hair loss in alopecia areata can lead to much distress in many patients. To receive the best alopecia areta treatment results, Dr.Ng offers a personalised treatment plan that is unique to your condition. Contact us to schedule an appointment with Dr.Ng today.
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References:
- Chang KH, Rojhirunsakool S, Goldberg LJ. Treatment of severe alopecia areata with intralesional steroid injections. J Drugs Dermatol. 2009 Oct. 8(10):909-12.
- Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, Atopic, and Mental Health Comorbid Conditions Associated With Alopecia Areata in the United States. JAMA Dermatol. 2013 May 22. 1-5.
- Rajabi, F., Drake, L., Senna, M. and Rezaei, N. (2018), Alopecia areata: a review of disease pathogenesis. Br J Dermatol, 179: 1033-1048.
- 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.
ABOUT DR MOSES NG
MBBS (London) with distinction
Dip Practical Dermatology (Cardiff) with distinction
Member of American Acne & Rosacea Society
Fellow of American Society for Laser Medicine & Surgery
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Dr. Moses Ng is a distinguished professional in the field of aesthetic medicine, renowned for his expertise in advanced cosmetic procedures. With over 15 years of experience, extensive training and a keen eye for detail, Dr. Ng specializes in a wide range of treatments, including injectables, laser therapies, and acne scar management.
Dr. Moses Ng’s commitment to excellence and patient-centric approach have earned him a reputation as a trusted clinician in aesthetic medicine. His continuous pursuit of the latest advancements in the field ensures that his patients receive the highest standard of care and the most effective treatments available.