Alopecia Areata

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Alopecia Areata

“The more hair you lose, the more head you get.”

Alopecia Areata (AA) is an autoimmune (disease in which your immune system attacks the healthy cells) dermatological disease which causes hair loss. “Alopecia” means baldness, and “areata” means a patchy type of hair loss. It is a chronic (long-lasting) inflammatory disease that affects the hair follicles. Patchy hair loss most commonly occurs in the scalp but can affect other parts of the body as well. In most people with this condition, hair falls out in small, round patches the size of a quarter; leaving behind coin-sized areas of the bare scalp. Even though in many cases, hair loss can be extensive and unpredictable, it is not a contagious disease.

AA affects people of all ages, although it is commonly seen in adolescence or early adulthood. Hair loss can be temporary or permanent that can involve the scalp or the whole body. In addition to hair loss, some affected individuals have pitted fingers or toenails.

Although it is not a very serious disease, it may cause anxiety among affected people. For understanding the symptoms, causes and treatment of Alopecia Areata, consult ​​Dr Priyanka Reddy, the best dermatologist in DNA Skin Clinic and Wellness Centre, Bangalore.

Who Gets Alopecia Areata?

Anyone can have alopecia areata, men and women are equally affected. It affects all ethnic and racial groups. The onset of the disease can be at any age, but most people get it in their teens, twenties, or thirties. It is more extensive and progressive if children less than 10 years are affected. It can be hereditary in 20% of individuals. However, in many people, there is no family history seen.

Types of Alopecia Areata

  • Alopecia Areata Multilocularis- It is the most common type. Hair loss occurs in multiple coin-sized patches on the scalp or other parts of the body.
  • Alopecia Areata Monolocularis- Baldness is present in only one spot. It may occur anywhere in the head.
  • Alopecia Totalis - It is a chronic (long-lasting) condition of complete hair loss of the scalp. Alopecia Universalis - It is a rare type, where there is complete or nearly complete hair loss on the scalp, face, and rest of the body.
  • Diffuse Alopecia Areata - It is a type of AA, where hair loss is scattered and widespread. Ophiasis alopecia - Hair loss which follows a band along the sides and lower back of the scalp.
  • Alopecia Areata Barbae- Hair loss is limited only to the beard in men.

Alopecia Areata Causes and Risk Factors?

In Alopecia Areata, the hair follicles are most commonly affected. Normally, your immune system protects the body from foreign invaders, such as bacteria and viruses. These invaders are recognised and attacked, clearing them from the body. In autoimmune disorders, the immune system is misguided and tends to attack its own body. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, your body's own immune system attacks the hair follicles and disturbs normal hair formation. This leads to abnormal loss of hair which may or may not regrow. Genetics also plays a vital role in alopecia areata, because many genes are found to be important for the functioning of the immune system.

Emotional stress or an illness also can be a leading cause of alopecia areata.

You are more likely to have alopecia areata if you have :

  • Asthma (a disease in which the airway passages in the lungs become narrow. This causes cough, wheezing and shortness of breath)

  • Down syndrome (a genetic disorder causing developmental and intellectual delays)

  • Pernicious anaemia (a disease in which the red blood cells are reduced due to deficiency of Vitamin B12)

  • Seasonal allergies (especially hay fever, causing itchy, watery eyes, and sneezing)

  • Thyroid disease (a disease in which there is abnormal functioning of the thyroid gland and hormone production)

  • Vitiligo (a disease that causes loss of skin colour in patches)

"Nivolumab-induced alopecia areata" - is a condition which occurs in people who are being treated with the chance drug nivolumab. In this case, hair loss is a sign that the drug is working.

Hair changes

  • Hair loss- The main symptom of alopecia areata is hair loss.

    • Hair usually falls out in round or oval patches on the scalp, leaving behind coin-sized bald areas. Other parts of the body may also be affected, such as the beard area in men, or the eyebrows or eyelashes.
    • The loss of hair can be sudden, developing in a few days, or over a period of a few weeks.
    • More hair loss is observed in cold weather.
    • About 30% of the affected individuals find that their condition either becomes more extensive or becomes a continuous cycle of hair loss and regrowth.·
  • "Exclamation Mark Hair"- These are often short hair around the patches that are narrower at the base than the tip.

  • “Cadaver Hair” - This is where hair breaks before reaching the skin surface.

  • Other symptoms- Sometimes the affected individuals complain of tingling, burning or itching on patches of the skin right before the hair begins to fall out.

Nail Changes

Alopecia areata can also affect the fingernails and toenails and sometimes this is the first sign.

  • Nail changes can cause severe disfigurement and loss of function. If there is extensive hair loss, nail changes such as ridges and pits (dents) develop. The nails become rough and lose their shine.

  • The nails may become thin and split.

  • White spots and lines may also appear on the nails.

How Long Does Hair Loss Last?

Individual episodes of hair loss last less than one year, in half of the patients with alopecia areata. In such cases, hair grows back without treatment. These patients may experience recurrent episodes of hair loss that spontaneously regrow or respond to treatments quickly.

Other patients have more stubborn hair loss that is progressive; wherein hair does not grow back on its own and may not respond to different treatments.

Complications of Alopecia Areata

  • Poor quality of life caused due to distress.

  • Increased depression (mainly due to cosmetic reasons because of loss of hair)

  • Other autoimmune disorders e.g., diabetes, vitiligo, thyroid disease.

How is Alopecia Areata Diagnosed?

  • Hair pull test - Can help confirm hair loss and is often positive in AA. Your dermatologist will grasp 40-60 closely grouped hair and apply a gentle grip. If more than 10% of hair is easily pulled out, then this test is considered positive

  • Trichoscopy -Examination of the hair follicle, hair shaft, and scalp with a dermatoscope (a device used to examine the skin structures that are not visible through the naked eye). The presence of yellow dots, small exclamation mark hair, and black dots (destroyed hair in the hair follicle opening) are indicative of AA

  • Skin Biopsy - A small piece of skin is removed from the scalp and looked under a microscope.

  • Blood tests - Is done to rule out other autoimmune disorders.

Treatment of Alopecia Areata

Medical Treatment

Topical Agents:

These medications are rubbed over the scalp to stimulate hair growth. A number of medications are available, both over the counter (OTC) and by prescription.

  • Minoxidil - A OTC drug which is commonly used, but it is not FDA approved. It is usually useful for people with limited AA, and generally takes 4-6 months, or longer to see the results. Consult your dermatologist before applying it to areas such as the scalp, eyebrows and beard.

  • Anthralin -This acts by irritating the skin to stimulate hair growth.

  • Topical Steroids (creams, foams, lotions, and ointments) - These work by decreasing the inflammation in the hair follicles. Adverse effects such as itching, stomach ulcers, and diabetes are seen after long-term usage.

  • Topical immunotherapy- is the most effective treatment for total hair loss. It is a technique in which a chemical is applied to the skin to spark an allergic rash which induces hair growth. Visible results may take up to 6 months.

Injections:

  • Steroid injections are a common option for mild, patchy alopecia. Steroids are injected in the scalp by tiny needles. This stops the immune system from attacking the hair follicles. The treatment has to be repeated every 1 to 2 months to regrow hair, but it does not prevent new hair loss from occurring.

  • Intralesional corticosteroids - A dermatologist injects the steroid directly into the skin with a small needle after cleaning the area with an antiseptic solution. It can be repeated every 4-8 weeks.

Oral treatment:

  • Oral Steroids are sometimes used for extensive alopecia, but it has many side effects.

  • Oral immunosuppressants are other options that may be suggested by your dermatologist. These block the immune system response, but they cannot be used for a long time due to the risk of possible side effects.

Laser and Light Therapy

Light therapy is also called photochemotherapy. It uses specific wavelengths of ultraviolet light for the healing effect. Laser treatment delivers a specific radiation dose which encourages new hair growth. Both these therapies are considered to be safe and effective. Consultation for light therapy for alopecia areata can be taken from Dr Priuyanka Reddy, the best dermatologist in DNA Skin Clinic and Wellness Centre, Bangalore.

Natural/Alternative Treatment

These treatments are all experimental and do not have any scientific evidence for their effectiveness.

  • Natural and alternative treatments include acupuncture, aromatherapy, vitamins and supplements (zinc, biotin), essential oils and other oils (coconut, castor, tea tree oils), and probiotics. These should not be taken without the advice of your dermatologist.

  • Reduce stress- You can reduce stress with the help of meditation, yoga, adequate sleep, relaxing by listening to music, connecting with other people, following a healthy lifestyle, and exercising.

  • Sunglasses - To protect the eyes and make hair loss less noticeable

  • Anti-inflammatory diet- Eating this diet reduces the body's immune response and further hair loss by decreasing inflammation. Blueberries, nuts, seeds, lean meat, beans, and broccoli are some examples.. This is known as "autoimmune protocol".

  • Wig, hairpiece, eyelashes- Your dermatologist may recommend this option when other treatments take time. A wig or a hairpiece can cover up lost hair right away. This is used especially when hair loss lowers the self-esteem of the individual causing anxiety or depression. "Vacuum wig", is a new wig technology, which is made with silicon and a suction base. This helps the individuals to swim with their wigs still in place..

  • Stick-on eyebrows- Dermatography (filling in eyebrows with makeup or a tattoo)

The effectiveness of each treatment varies from person to person. For some people, hair may grow back on its own so it may not need any treatment. However, in some cases, people won't see any improvement despite trying every possible treatment option.

People might need to try more than one treatment to see the difference. The hair regrowth may be temporary, because the hair may fall out again.

Alopecia Areata Outlook

Alopecia areata is not a serious or life-threatening disease. However, it can cause a lot of anxiety, stress, sadness, and low self-esteem. Support groups are out there to help you deal with the psychological effects of the disease. These groups consist of doctors, nurses, and other healthcare workers, as guest speakers who counsel and motivate you.

Even though there is no cure for alopecia areata, the symptoms can be controlled by consulting with your dermatologist. Take an appointment with Dr Priyanka Reddy, the best dermatologist in DNA Skin Clinic and Wellness Centre, Bangalore for guidance on the right treatment and advice.

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