The Fundamentals Of Alopecia Areata

February 9, 2023

Alopecia areata is a common autoimmune condition that often results in the patient losing variable amounts of hair, ranging from a few chunks to becoming completely bald. The disorder affects approximately 6.8 million Americans and can affect both genders at any age. Learn more now about this prevalent condition, what causes it, how it is diagnosed, and what the treatment options are for individuals who are dealing with it.

What Exactly Is Alopecia Areata?

Alopecia areata is a form of hair loss occurring when an individual’s immune system attacks the hair follicles, where hair growth begins, by accident. The damage to the hair follicle is typically not permanent, as a majority of those afflicted recover from the disorder quite effortlessly. Alopecia areata is most common in patients younger than twenty, with children being the most targeted group by this disorder.

However, adults and children of any age can be affected. The severity of the disorder varies, as sometimes it can lead to complete hair loss on the scalp, known as alopecia totalis, or, in extreme cases, it can destroy hair follicles all over the body called alopecia universalis. This autoimmune condition often develops suddenly and over the course of a few days, and patients who experience alopecia areata and who only have a few patches of hair loss typically make a quick, spontaneous, full recovery without treatment.

Signs And Symptoms Of Alopecia Areata

There are numerous visible and obvious signs a patient may be suffering from alopecia areata, as the condition usually begins when clumps of hair fall out randomly, resulting in smooth, round, and hairless patches on the scalp or body. In some specific cases, the hair may become thinner without noticeable baldness, or the hair may grow and break off, resulting in short stubs called ‘exclamation point’ hair. In incredibly rare cases of the syndrome, complete hair loss either on the scalp and body occurs. The hair loss is sporadic, as the hair will grow back approximately within several months, however, it will fall out in other areas on the scalp or body. Although the hair usually grows back the same color and texture, it sometimes can grow back fine and white.

Approximately ten percent of patients may never grow back their hair, as those afflicted with this syndrome are more likely to have permanent hair loss if they develop the condition at a young age, generally before puberty, or for longer than a year, have other autoimmune diseases, and are prone to allergies. Other causes for permanent hair loss include extensive hair loss, and abnormal color, shape, texture, or thickness of the fingernails or toenails, as the nails appear pitted, as if a pin has made many tiny dents in them, or resemble sandpaper.

What Causes Alopecia Areata In Patients?

Although once believed to be caused by high levels of stress, as some other forms of baldness can result from it, alopecia areata is caused by genetic factors. There is very little scientific evidence to support the claim alopecia areata is caused by stress, although in extreme cases, stress can trigger the condition to occur. As mentioned earlier, this condition occurs when the immune system attacks the hair follicle causing it to fall out. Specifically, the white blood cells attack the follicle cells, causing them to shrink and dramatically slow down hair production.

It is still unknown as to why the body’s immune system targets hair follicles in this manner, however, scientists believe it is related to genetics. One in five patients with the disease has a blood relative who also developed the condition, indicating genetics is a major cause. Further research has indicated many patients with a family history of alopecia areata also have a personal or family medical history of other autoimmune disorders, such as thyroiditis, vitiligo, and atopy.

How Is It Diagnosed?

Alopecia areata is diagnosed through a review of an individual’s medical history and a physical examination. The physician will ask the patient questions about their hair loss, look at the pattern of the hair loss either on the scalp or body and may even remove some hairs from the affected areas. Tests doctors can perform to determine if the patient is suffering from alopecia areata include a hair analysis, where a sample of hair or the scalp is analyzed under a microscope, or a blood test, which can test for specific conditions, and rule out the possibility it is another autoimmune disorder.

For Individuals Who Do Not Pursue Treatment

Unfortunately, there is no cure for alopecia areata, however, there are numerous treatment options available that can quickly heal the affected areas, and provide the individual with a sense of normalcy. Most individuals who experience one episode of hair loss will have more episodes within the future, however, since the fallen hair will grow back within a year or less, many patients often decide not to treat it.

If left untreated, patients can deal with the temporary hair loss by wearing hair pieces, such as wigs or extensions, however, hair weaving is not recommended to cover the bald spots as it requires sewing or braiding pieces of hair into the existing hair, which may cause permanent hair loss in certain areas. Individuals can also try specific hair care products and styling techniques to conceal bald spots, but continued use of perms or dyes may result in further hair loss.

Treatment Options Available To Patients

For patients who do decide to treat this syndrome, the most common treatment for patchy hair loss is injections of corticosteroids into the scalp or skin, approximately one centimeter apart, every four to six weeks. Corticosteroids are also available in a topical cream patients can apply to the affected skin, and minoxidil or Rogaine can be used along with the topical form. Anthralin is another common treatment, and it is an ointment that can help regrow hair within two months or more. This ointment appears and feels like tar, and its side effects include possibly irritating and staining the skin. Therefore, it is only applied to bare patches on the scalp for a short period, then washed off.

Contact immunotherapy is also another medical treatment used that can produce an allergic reaction on the scalp and may aid in hair regrowth. Essentially, contact immunotherapy is a medicine ‘painted’ on or applied to the scalp once a week, which irritates the skin, resulting in it becoming red and scale-like. On a positive note, hair growth may appear within three months of using this treatment, however, the negative side effects include a severe rash developing, known as contact dermatitis, and swollen lymph nodes in the neck.

Lasting Effects That Impacts A Patient’s Life

Although this common disorder is highly treatable and manageable for individuals living with it, it can negatively impact a person’s self-worth and confidence. Alopecia areata does not affect a patient the way other autoimmune conditions do, as it is not painful, it does not make the patient feel ill at any time, and it does not lead to other critical health problems. This condition is not contagious, and it generally will not interfere with a person’s school, home, work, or recreational activities. However, this condition can make the patient feel unattractive, considering our society deems our appearance and hair as highly valuable and a representation of who you are. If the patient is feeling self-conscious about their hair loss, it is recommended they talk to someone, such as a counselor or loved one, and reach out to support groups and others affected by the condition to bring comfort and ease their insecurities.

Despite how the condition looks, it is essential for patients to remember their hair or lack of do not define them, and alopecia areata is a highly treatable and manageable condition. Individuals can still live an enjoyable and fulfilling life with it!

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