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Alopecia areata is a common condition that results in the loss of hair on the scalp and elsewhere. It usually starts with one or more small, round, smooth patches. It occurs in males and females of all ages, but young persons are affected most often.
Normally, hair follicles on the scalp are producing 35 meters of hair each day. In alopecia areata, the affected hair follicles slow down production drastically, become very small, and grow no hair visible above the surface for months or years. While in this hibernation-like state, the hair follicles remain alive below the surface and are ready to resume normal hair production whenever they receive the appropriate signal.
Some people develop only a few bare patches and regrow them within a year, even without treatment. The scalp is the most commonly affected area, but the bear in men, or any hair-bearing site, can be affected alone or together with the scalp. In some, the condition spreads until all the hair on the scalp is lost - alopecia totalis. In others, all the hair on the entire body is lost - alopecia universalis. No matter how widespread the hair loss, the hair follicles remain alive below the skin surface, and the possibility of hair regrowth remains.
WHAT IS THE SIGNAL THAT TRIGGERS THE CONDITION TO START OR STOP?
It's not clearly known, but evidence is mounting that an immunological signal is involved. Modern immunological research is showing alopecia areata is probably an autoimmune disorder, one in which the body forms antibodies against some part of the hair follicle (a type of "self-allergy"). In those with alopecia areata, other antibodies directed against other normal parts of the body are also sometimes present, even though there is no disease or disability associated with these other antibodies.IS ALOPECIA AREATA HEREDITARY?
Heredity sometimes plays a role. In one out of five persons with alopecia areata, someone else in the family has also had it. Alopecia areata often occurs in families whose members have had asthma, hay fever, atopic eczema, or other autoimmune conditions such as thyroid disease, vitiligo, early-onset diabetes, rheumatoid arthritis, lupus erythmatosus, pernicious anemia, or Addison's disease.WHAT OTHER PARTS OF THE BODY ARE AFFECTED?
In some, the nails may develop stippling that looks as if a pin had made tiny dents in rows across the nail. In a few, the nail changes are extensive. However, other than the hair and occasionally the nails, o other part of the body is affected.HOW WILL IT AFFECT MY DAILY LIFE?
In a physical sense, alopecia areata is not disabling at all; persons with alopecia areata are usually in excellent physical health. In an emotional sense, it can be challenging, especially for those with extensive hair loss.One of the main purposes of the National Alopecia Areata Foundation is to reach out to individuals and families with alopecia areata and help them live full, productive lives. There are thousands of successful, well-adjusted, contented people living with this condition. The emotional pain of alopecia areata can be overcome with one's own inner resources, sound medical facts, and the support of others. Sometimes professional counseling from a psychiatrist, psychologist, or social worker is needed to develop one's self-confidence and good self-image.
DOES THE HAIR EVER GROW BACK?
Yes, the hair definitely can grow back, and in some cases it can fall out again.IS IT NECESSARY TO CHANGE PLANS REGARDING SCHOOL, SPORTS, FRIENDS, CAREER, DATING AND MARRIAGE?
No, not at all.WHAT TREATMENTS ARE AVAILABLE?
There are several treatments available; the choice depends mainly on the age and the extent of hair loss. Alopecia areata occurs in two forms: a mild patchy form where less than 50% of scalp hair is lost, and an extensive form where greater than 50% of scalp hair or all the scalp hair is lost. These two forms of alopecia areata behave quite differently, and the choice of treatment depends on which form is present. Current treatments do not turn alopecia areata off; they prod the sluggish follicle to produce normal hair again, and they all need to be continued until the condition turns itself off, which may take months or years.FOR MILD, PATCHY ALOPECIA AREATA...
CORTISONE INJECTIONS: For mild, patchy alopecia areata, the commonest treatment in this country is the injection of cortisone into the bare patches. The injections are usually given by a dermatologist who uses a tiny needle to give multiple injections into the skin and in and around the bare patches. The injections are repeated once a month. Both the needle prick and the slight tingling are usually well tolerated by most people, and there is no discomfort after leaving the doctor's office. New hair growth is usually visible four weeks later. Treatment, however, does not prevent new patches from developing. There are few side effects from local cortisone injections. Occasionally, temporary depressions i the skin result from the local injections, but these "dells" usually fill in by themselves.ANTHRALIN CREAM OR OINTMENT: Another treatment for mild, patchy alopecia areata is the application of anthralin cream or ointment. Anthralin is a synthetic, tar-like substance that has been wisely used for psoriasis.
Anthralin is applied as a cream or ointment to the bare patches once daily and washed off after a short time, usually 30 to 60 minutes. New hair growth is often seen in eight to twelve weeks. Anthralin can be irritating to the skin and cause temporary, brownish discoloration of the treated skin. By using short treatment times, skin irritation and skin staining are reduced without decreasing effectiveness. Care must be taken not to get anthralin in the eyes, and hands must be washed after applying it.
TOPICAL MINOXIDIL: Topical minoxidil is the newest treatment for alopecia areata. It is discussed later.
FOR EXTENSIVE ALOPECIA AREATA, OR ALOPECIA TOTALIS/ALOPECIA UNIVERSALIS...
WIGS: For extensive alopecia areata, or alopecia totalis/alopecia universalis, treatment is more difficult. There is no simple, sure solution and for this reason an attractive wig is often the best alternative. There are many ways to make a wig look completely natural, and every wig has to be cut, thinned, and styled, often several times, until it is just right. To keep a wig from falling off, even during active sports, special double-sided sticky tape can be purchased in beauty supply outlets and fastened to the inside of the wig. There are also suction caps to which any wig can be attached, or there are entire suction cap units.CORTISONE PILLS: Cortisone pills are sometimes given for extensive scalp hair loss or when the condition is rapidly spreading. Cortisone taken internally is much more powerful than local injections of cortisone into the skin. It's necessary to discuss possible side effects of cortisone pills with your physician. Healthy, young adults often tolerate cortisone pills well and with few side effects. In general, however, cortisone pills are used in relatively few patients with alopecia areata because they often must be given for prolonged periods, and the regrown hair may fall out when the cortisone pills are stopped.
ALLERGIC CONTACT DERMATITIS: Another method of treating extensive alopecia areata, or alopecia totalis/universalis, is to produce an allergic rash or allergic contact dermatitis. Chemicals such as dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester are applied to the scalp to produce an allergic rash which resembles poison ivy or poison oak. Approximately half the patients treated with allergic contact dermatitis will regrow the scalp hair.
Those who do successfully regrow the hair still need to continue the treatment to maintain the hair regrowth, at least until the condition turns itself off. An itchy rash may be uncomfortable in very hot weather, especially under a wig. One must also be careful not to produce an itchy, allergic rash on other parts of the body. Treatment with DNCB or squaric acid dibutyl ester is not available everywhere; those interested need to locate a dermatologist or medical center where these treatments are available.
PUVA: Extensive alopecia areata is sometimes treated with PUVA which combines the use of a light-sensitizing medication (psoralen) and long wave ultraviolet light (UVA). In a modest number of patients, hair regrowth is stimulated with this method. Treatments are given two or five times a week for many months at a medical center or dermatologist's office. Because of this frequent travel to a treatment center, PUVA therapy is time consuming.
There is also some concern about the long-term safety of the intensive ultraviolet light irradiation of the skin. As with DNCB, PUVA therapy is available only at some medical centers and some dermatologists's offices.
TOPICAL MINOXIDIL: Minoxidil is a drug used to treat severe high blood pressure. One of the side effects of the oral form of the medications is a tendency to stimulate hair growth in various parts of the body. Studies have shown topical application of minoxidil in those with extensive and patchy alopecia areata will also grow hair. Twice-daily applications are needed, and, after a year of treatment, many will grow sufficient hair to cover the scalp. The eyebrows and beard may also respond to such treatment.
Unfortunately topical minoxidil is not effective in most individuals with 100% scalp hair loss. Minoxidil solution (Rogaine) is safe and easy to use.
WHAT RESEARCH IS BEING DONE?
There is extensive world-wide research focusing on the cause and treatment of alopecia areata/totalis/universalis. The National Alopecia Areata Foundation is leading this research effort by raising private funds and awarding grants to university centers in the United States and Europe, and by working closely with the government to increase federal funding for alopecia areata research. Studies of the immunologic, genetic, vascular, and other changes in alopecia areata are in progress. All these investigative efforts will lead to better treatments for both the mild and extensive forms of alopecia areata.For more information on alopecia areata or how to receive the National Alopecia Areata Foundation bi-monthly newsletter, contact the Foundation:
The National Alopecia Areata Foundation
714 C Street, Suite 216
San Rafael, CA 94901
(415) 456-4644
Medical information prepared by Vera H. Price, M.D.
© 2006 Pacific Monograph