About Alopecia

About Alopecia Areata

What is believed to be Alopecia Areata?What Causes Alopecia Areata?AA / Children / TreatmentsTo Treat or not to TreatTests

What is believed to be Alopecia Areata?

Alopecia areata is a disorder that causes sudden hair loss on the scalp and other regions of the body. It affects 4 million Americans, 60% of them under the age of 20, similar figure are for Europe.

The GOOD NEWS IS that Alopecia Areata is a reversible type of hair loss.

Alopecia Areata (AA) may be an autoimmune related disease. AA strikes without warning, and can “come and go” just as suddenly. It is not a health threat, but can be psychologically damaging, especially for children, to cope with baldness. Alopecia areata can either be mild, where less than half of the scalp is affected, or extensive, where more than half the scalp is involved.

There are many subtypes, based on the pattern and location of hair loss. The three most common are:

  • Alopecia Areata (AA): bald patches on the scalp
  • Alopecia Totalis (AT): total loss of scalp hair
  • Alopecia Universalis (AU): hair is lost on the entire body including eyebrows, lashes and nose hair.

These different subtypes of AA may be indirectly influenced by the presence of certain allergies or genes affecting our blood immune system. The different hair loss patterns (patchy, reticular, ophiasis, alopecia barbae, etc.) could also reflect different methods of disease development for different people and age.

The more severe forms of alopecia areata can arise unpredictably. They are more likely if the hair loss starts very young, if the initial hair loss is very severe, and in individuals who also suffer from eczema or asthma. Alopecia areata does not result in physical disability, but it can be emotionally very distressing.

The earlier the treatment the better the results.

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What Causes Alopecia Areata?

There are many factors in the genesis of Alopecia disease. Critical also are genetic susceptibility, environmental exposure to pathogens and pollutants, hormonal imbalances, physiological stress on the body and diet, just to name a few.

There are many factors in the genesis of Alopecia disease. Critical also are genetic susceptibility, environmental exposure to pathogens and pollutants, hormonal imbalances, physiological stress on the body and diet, just to name a few.

  • It’s not yet known what causes alopecia areata. For some reason, follicles stop producing visible hair, resulting in smooth bald patches that can appear overnight. Researchers are trying to determine what triggers the disease, and whether it’s within the body or from environmental factors.
  • There are a few symptoms before bald patches appear (itching, inflammation etc). However, there may be some hereditary factors. About 20% of people with alopecia areata have a family member who is also affected.
  • Atopy, a genetic condition that predisposes people to hay fever, eczema, asthma and other autoimmune diseases, is often associated with alopecia areata.

There may be multiple susceptibility genes for AA, different combinations of which may be found in different people with AA. However, it is clear that having susceptibility genes is not always enough for AA to develop. There are probably environmental trigger factors also, interacting with susceptibility genes to promote the onset of AA.

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AA / Children / Treatments

Experts say that Children may be more susceptible and may develop alopecia areata also. Nearly 2% of people in the U.S. and Europe, many of them children, suffer from alopecia areata, a skin disorder that causes hair to fall out in patches.

The cause of the disease is difficult to determine, and there is presently no cure by orthodox medicine.

Some researchers believe that several genetic factors may play a major role in autoimmune disease.

Parents would give anything to help and see their child’s hair return. Unfortunately all too often the first visit to the GP can lead to tears, it seems that most GP’s are inadequately prepared to cope with children’s Alopecia, and would dismiss the sufferer/parent fears with “your hair will grow back” or at worst possible scenario will look at them as time wasters. In a few cases would tell the parents “buy him/her a wig, they make good quality wigs these days” and walks away.

Hair loss in otherwise healthy children presents several challenges for the clinician. The first task may be to identify the cause, which may be complicated by two or more secondary factors; the second task is to find effective treatments;

Some Doctors fail to recommend or undertake any tests and yet there is clearly a need that diagnostic tests should be considered.

Doctors should routinely order laboratory tests for patients where there is no obvious cause, unfortunately, there are no guidelines and if there are, alopecians are not told. In most cases in the first incident of AA, the majority of cases will have at some stage, a spontaneous response.

It is important to understand that although the disease itself is non-life threatening, the cosmetic and psychological impact on both patients and parents is tremendous and may lead to a high lifetime prevalence rate of major depression and/or generalised anxiety disorders. Mood disorders, especially depression, are common early on in the course of alopecia areata. It is natural to be overcome by fear and depression when facing an uncertain future.

What we alopecians want to hear is some explanations about our hair loss, encouragement and understanding about what the future may hold, AND NOT to be told that an appointment arranged with the local consultant dermatologist is in five, six months time.

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To Treat or not to Treat

Medicines, which are often tried, include: topical steroids, irritants such as dithranol, and minoxidil. For extensive hair loss, there is no reliable treatment. A special form of ultraviolet light treatment (PUVA) is sometimes on offer, and may also result in side effects.

Cortisone pills are used for extensive cases, a solution of Minoxidil applied to the scalp twice a day. Depending the “expert”, minoxidil 2 or 5% will not be used on its own but most likely with a steroid cream combination.

Doctors choose your treatment and some will advocate Cortisone injections directly into the bald areas once a month. Many patients grow some new hair in treated areas within a few weeks, but cortisone does not prevent new bald patches from occurring.

There may be some temporary regrowth in the area that has been injected. Unfortunately, there is no way of preventing new areas of hair loss developing new patches or expanding in size the existing AA patches.

Some steroid lotions applied to the scalp do seem to result in temporary improvement in some people, but in most cases the hair falls out again as soon as they stop the treatment. Unfortunately Steroid treatments can only be used for a limited time because of fears of severe side effects.

However if there is regrowth, you are encouraged to undertake further injections. Once the injections stop, again, it is most likely that all newly grown hair will fall again. In a few well-documented cases, the injections may have a catastrophic effect by accelerating the AA patches to Alopecia Universalis.

Topical, intralesional, and systemic treatment using Corticosteroid drugs is the most common treatment approach in dermatology clinics.

The longer the steroid treatment goes on, the more the chances of side effects and this must be a constant worry.

  • We are told that about 40% of patients who undergo one or more of these treatments regrow hair about six months later.
  • We are not told how many of these “regrowths” relapse. (My guess is that a high number may be involved in relapse).

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Tests

Very few Alopecians (in UK) are encouraged to undertake diagnostic laboratory tests where there is no obvious cause.

Few Doctors understand the need for tests, and some may refuse point blank.

Doctors may recommend one or more of the following:

  • CBC (complete blood cell count), including hemoglobin, vitamin B12 and ferritin values for iron stores.
  • ESR (erythrocyte sedimentation rate)
  • ANA (antinuclear antibody)
    Thyroid function tests, the thyroid panel should include total and free T4, T3 and thyroid stimulating hormone (TSH).
  • If he patient suffers from allergies and/or other autoimmune condition may be advised also to consider an IgA test.
  • If no cause is obvious, the Doctor may need to consider a skin biopsy.

NOTICE: The information provided is strictly educational and not intended as medical advice. For diagnosis and treatment, consult your physician. E&OA

For more information visit www.naaf.org

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