Alopecia areata

The term alopecia means hair loss. In the form of alopecia known as alopecia areata, round bald patches appear suddenly, most often affecting the scalp.

Alopecia areata can occur at any age, including in childhood.

Alopecia areata

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What causes alopecia areata?

Alopecia areata is considered to be one of the autoimmune disorders - lymphocytes aound the hair follicles release chemical messengers (called cytokines) that reject the hair for unknown reasons.

Alopecia areata may occur in more than one member of the family, and such families may develop other autoimmune diseases such as pernicious anaemia and vitiligo. It is also more common in patients with chromosomal disorders such as Down syndrome.

Like many other health problems, it sometimes starts after a stressful event. Alopecia areata itself may be emotionally very distressing.

What does it look like?

Alopecia areata is often discovered by a hairdresser, as there are usually no symptoms. The hair stops growing and then falls out from the roots. Alopecia areata has three stages. First there is sudden loss of hair, then enlargement of the patches of hair loss. Lastly new hair grows back, often initially coloured white or grey. It may take months and sometimes years to regrow all the hair. One patch can be falling out while another is regrowing.

Any hair-bearing area can be affected, including eyebrows, eyelashes, beard and body areas.

Alopecia areata

Alopecia totalis

Varieties of alopecia areata

Some people with alopecia areata do not have typical round bald patches.

Alopecia totalis	Affects up to 5% of affected individuals All scalp hair is lost
Alopecia universalis	Affects less than 1% of cases All hair on entire body is lost
Alopecia areata incognita	Sudden diffuse thinning of scalp hair May be confused with telogen effluvium
Nail disease	Affects 10-50% of those with alopecia areata Many nail changes have been described Regular pitting and ridging are the most common findings

The more severe forms of alopecia areata 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 atopic eczema or asthma.

Treatment

Unfortunately there is not yet any reliable cure for alopecia areata. Luckily the hair usually grows back slowly by itself. Sometimes the new hair may regrow grey or white, but after a while the original colour usually returns.

Injecting a cortisone medicine into the area of hair loss may speed up the natural regrowth of hair. This treatment is known as an ‘intralesional steroid injection’. The regrowth occurs only in the area that has been injected. There is no way of preventing new areas of hair loss. However if they appear, regrowth can be helped by further injections.

Many other treatments have been introduced for alopecia areata, but the results are variable - no one has yet devised anything that works for everyone. Some lotions applied to the scalp do seem to result in temporary improvement in some people, but the hair falls out again as soon as they are stopped. Medicines which are often tried include topical steroids and minoxidil, and irritants such as dithranol.

The most successful treatment to date has been immunotherapy. Immunotherapy works by provoking a contact allergic dermatitis in affected areas by applying a low concentration of a material to which the patient has been made allergic. This is most often diphenylcyclopropenone (diphencyprone). Unfortunately the resultant dermatitis is irritating and may be unsightly, often accompanied by a swollen lymph gland. Therapists and others in contact with the diphencyprone can also develop dermatitis.

For extensive hair loss, there is no reliable treatment. Steroid pills, or a special form of ultraviolet light treatment (PUVA), are sometimes worthwhile, but may result in side effects.

An attractive wig is often the best solution. Some people need professional counselling to come to terms with the disorder, regain self-confidence and live full, productive lives.