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Alopecia Areata

Definition

Alopecia areata is an immune disorder that causes hair loss. The immune system attacks healthy tissue that holds the roots of hair called the hair follicle. Damage to this tissue causes hair loss. Alopeica areata may be a brief event or long term, and it may recur.

Hair Loss
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Causes

Alopecia areata is an autoimmune disease. This means the immune system creates special antibodies that attack healthy tissue. In this case, the antibodies attack hair follicles and cause hair loss. The exact cause for the change in the immune system is not clear. It is most likely a combination of genes and factors in environment.

Risk Factors

Alopecia areata is more common in people under 30 years old. Other factors that may increase your chance of alopecia areata include:

Symptoms

Alopecia areata causes sudden, patchy hair loss. Hair loss occurs most often on the scalp but can happened in beards, eyebrows, or any where on the body. Rarely, someone can lose all hair all over their body.

Alopecia areata can also affect the fingernail or toenails. It can cause tiny dents in the nail, discoloration, weakness, and breaking.

Diagnosis

Your will be asked about your symptoms and medical history. A physical exam will be done. The doctor will probably be able to make the diagnosis based on the exam.

There are tests that can confirm alopecia areata or rule out other causes of your hair loss. Tests may include:

  • Blood tests—to look for other possible autoimmune disease
  • Biopsy of scalp tissue to look for changes
  • Analyzing samples of hair
  • Culture of scalp to look for potential fungal infection

Treatment

There is no cure for alopecia areata. Hair will grow back on its own for most. The hair that grows back will look different at first but will eventually look like it used to. For some, hair will only fall out once, for others the hair may fall out and regrow over several cycles. The pattern of hair loss and growth is unpredictable and can last for years in some. Rarely, the hair will not grow back. This is more common in those with full body hair loss.

Treatment may help the hair regrow faster. Options include:

Medications

Medications to treat alopecia areata may vary depending on your age and include:

  • Topical corticosteroids
  • Corticosteroid injections into the scalp
  • Topical medications that alter the immune system
  • Topical minoxidil

Photochemotherapy is a method that uses a UV light to help the body better use certain medications.

Surgery

Surgical procedures may be an option if medications do not work. Some of these include:

  • Laser therapy—To treat patches on the scalp.
  • Hair transplant—Taking hair from the back and sides of the head and transplanting it in bald areas. Hair transplant involves multiple procedures.
  • Scalp reduction with flaps—Cutting the scalp and pulling the areas with hair closer together.
  • Medical tattooing—Colored pigments can be injected into the eyebrows.

Other Treatments

Hair loss can cause social anxiety for some. Cosmetic changes like a wig or hairpiece may help some feel more comfortable. Counseling or support groups may also be helpful.

Prevention

There are no current guidelines to prevent alopecia areata since the cause is unknown.

Revision Information

  • American Academy of Dermatology

    http://www.aad.org

  • National Alopecia Areata Foundation

    http://www.naaf.org

  • Derm Web

    http://www.dermatology.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Alopecia areata. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/alopecia-areata. Accessed August 5, 2015.

  • Alopecia areata. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116937/Alopecia-areata. Updated May 5, 2016. Accessed September 30, 2016.

  • Alopecia areata. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Alopecia%5FAreata/default.asp. Updated April 2015. Accessed August 5, 2015.

  • Mitchell AJ, Douglass MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985;12(4):644-649.

  • Price VH. Treatment of hair loss. N Engl J Med. 1999;341(13):964-973.

  • Rawnsley JD. Hair restoration. Facial Plast Surg Clin North Am. 2008;16(3):289-297.

  • Taylor CR, Hawk JL. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology. Br J Dermatol. 1995;133(6):914-918.

  • Types of hair loss. American Hair Loss Association website. Available at: http://americanhairloss.org/types%5Fof%5Fhair%5Floss/introduction.asp. Accessed August 5, 2015.