Alopecia areata (or AA) is a common type of hair loss affecting both men and women of all ages, and most often in children and young adults. It usually starts as sudden falling out of hair as one or more small round patches on any part of the body. There is no pain or itch associated with the hair loss, and a person may not be aware of it until someone else notices it.
It is most noticeable on the scalp. The hair follicles become very small. Hair growth slows down and may not grow beyond the scalp surface for months. The scalp is most commonly affected. Some lose a few bald spots that regrow hair in few months. In others, extensive patches occur. In a few people all the hair is lost (known as alopecia totalis and alopecia universalis) and may be permanent. Normally, the hair follicles retain the ability to regrow later with or without treatment and even after many years.
The cells of the body immune system called lymphocytes attack the hair roots leading to weakened hairs and falling out of hairs. Attack on a body tissue by our own immune system is called autoimmune process. It is not entirely understood why autoimmunity develops. There is probably a genetic predisposition and a family history is reported by some affected individuals. Diet and nutritional deficiencies do not cause AA. There is also no conclusive evidence that stress causes it though it may aggravate the hair loss.
In the majority of cases, AA is an isolated autoimmune condition with no adverse effects on the rest of the body. It may occasionally be associated with vitiligo, thyroid problems and diabetes mellitus. However, the Alopecia causes emotional stress to those with extensive hair loss. They become depressed. The emotional pain leads to withdrawal from the society. Support, medical education and one’s mental strength will help. The doctor can help develop your self-confidence and self-image.
The natural course of AA is difficult to predict. The hair may grow back completely. In many patients AA may recur after a variable period of time at the same or different sites. In some cases, especially those having extensive hair loss, partial hair regrowth occurs. Sometimes, it can take years to regrow hair. There are no known effective methods to prevent recurrences.
Consult a dermatologist. The doctor will do a proper thorough hair examination. Blood tests are usually not necessary; they are done to exclude other types of hair loss. Treatment depends on whether the loss is serious and rapid, more or less than 50% loss.
Less than 50% loss, patchy
- Corticosteroid injection into the scalp helps. This can be repeated monthly, and there is little discomfort. Complications include temporary depression on the scalp from these injections.
- Topical minoxidil solution. This is used twice a day to stimulate hair growth.
More than 50% loss, extensive
- Corticosteroid tablets for acute loss. These may have side effects and health risks.
- Topical immunotherapy: application of chemicals such as diphencyprone (DCP) directly onto the bald areas to stimulate hair regrowth. DCP causes an allergic contact dermatitis and reverses the cause of the hair fall. This may take 5-6 months of weekly applications. The chance of hair regrowth, either spontaneous or after treatment, is good in most cases.
- Temporary use of wigs. An attractive wig will beautify a bald scalp. There is a range of quality and price; a better-fit wig will cost more.
- Topical PUVA (psoralen combined with ultraviolet A). This is a treatment involving the application of a light-sensitising solution followed by shining UVA on the bald scalp, 2 to 3 times a week. Treatment is time consuming and effective in only a small number of patients.
As mentioned above, various treatments are helpful. Research is being conducted into the causes and newer treatments. For example, there are studies on genes and gene therapy for the future.