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. It is a form of autoimmune hair loss.
Alopecia areata can occur at any age, including in childhood.
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 alopecia areata 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. There may be a few broken or tapered hairs within the bald patches. 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.
Varieties of autoimmune hair loss
Some people with autoimmune hair loss do not have typical round bald patches.
|Alopecia areata incognita||
The more severe forms of autoimmune hair loss 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 of alopecia areata
Unfortunately there is not yet any reliable cure for alopecia areata and other forms of autoimmune hair loss. 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 (anthralin), often delivered by the short-contact method.
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.
Some people need professional counselling to come to terms with the disorder, regain self-confidence and live full, productive lives.
Camouflaging hair loss
An attractive hairpiece is often the best solution to disguise the presence of hair loss. These cover the whole scalp or only a portion of the scalp, using human or synthetic fibres tied or woven to a fabric base.
- A full wig is a cap that fits over the whole head.
- A partial wig must be clipped or glued to existing hair.
- A hair integration system is a custom-made hair net that provides artificial hair where required, normal hair being pulled through the net.
- Hair additions are fibres glued to existing hair and removed after 8 weeks
It is best to select a wig prior to complete hair loss so that one may be chosen to mimic the natural hair color and allowing the patient to adjust emotionally.
Gels, mousses and sprays can be applied to keep hair in place and add volume. They are reapplied after washing or styling the hair.
Eyelashes and eyebrows
Artificial eyelashes come as singlets, demilashes and complete sets. They can be trimmed if necessary. The lashes can irritate the eye and eyelids. They are stuck on with methacrylate glue, which can also irritate and sometimes causes allergic reactions (contact dermatitis).
Eyeliner tattooing is a permanent solution and should be undertaken by a professional cosmetic tattooist. The colour does eventually fade and may move away slightly from the original site. It is extremely difficult to remove the pigment, should the result turn out to be unsatisfactory.
Tattooing can also be undertaken to disguise the loss of eyebrows, but tends to look rather unnatural because of the shine of hairless skin. Artificial eyebrows can be manufactured from synthetic or natural human hair on a netting that is glued in place. Alternatively, eyebrow pencil can be obtained in a variety of colours made from inorganic pigments and used to colour in the appropriate site.
- Guidelines for the management of Alopecia Areata (SP MacDonald Hull, ML Wood, PE Hutchinson, M Sladden and AG Messenger) BJD, Vol. 149, No.4, October 2003 (p692) – British Association of Dermatologists
- Draelos ZD. Camouflage technique for alopecia areata: what is a patient to do? Dermatologic Therapy 2011; 24:305-310
On DermNet NZ:
- The National Alopecia Areata Foundation, PO Box 150760, San Rafael, Ca 94915-0760, USA.
- Alopecia Support Group, PO Box 394, Manurewa, Auckland.
- Australia Alopecia Areata Foundation
- Children's Alopecia Project
- Alopecia areata – Medscape Reference
- Alopecia areata – British Association of Dermatologists
- British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. AG Messenger, J McKillop, P Farrant, AJ McDonagh and M Sladden, BJD, Vol. 166, No. 5, May 2012 (p916-926) PDF file
- Patient information: Alopecia areata (Beyond the Basics) – UpToDate (for subscribers)
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