Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss.
It affects roughly 6.8 million people in the United States.
In the majority of cases, hair falls out in small patches around the size of a quarter. For most people, the hair loss is nothing more than a few patches, though in some cases it can be more extreme.
Sometimes, it can lead to the complete loss of hair on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia universalis).
The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30.
In this article, we look at the causes and symptoms of alopecia areata, its diagnosis, and potential treatments.
There is currently no cure for alopecia areata, although there are some forms of treatment that can be suggested by doctors to help hair re-grow more quickly.
The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These are mostly commonly administered through local injections, topical ointment application, or orally.
Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE, and DPCP. Although some of these may help with the re-growth of hair, they cannot prevent the formation of new bald patches.
The use of photochemotherapy is supported by some studies and presents a potential alternative for patients unable or unwilling to use systemic or invasive therapies.
In addition to its aesthetic aspect, hair affords a degree of protection against the elements. People with alopecia areata who miss the protective qualities of hair may wish to:
- Wear sunscreen if exposed to the sun.
- Wear wraparound glasses to protect the eyes from the sun and debris which the eyebrows and eyelashes would normally defend against.
- Use headwear such as hats, wigs, and scarves to protect the head from the sun or keep it warm.
- Use ointment inside the nose to keep membranes moist and to protect against organisms that are normally trapped by nostril hair.
Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.
Support groups and counseling are available for people to share their thoughts and feelings, and to discuss common psychological reactions to the condition.
Alopecia areata has been compared by some to vitiligo, an autoimmune skin disease where the body attacks melanin-producing cells, leading to white patches. Research suggests that these two conditions may share a similar pathogenesis, with similar types of immune cells and cytokines driving the diseases and common genetic risk factors.
As such, any new developments in the treatment or prevention of either disease may have consequences for the other.
There have been a handful of documented cases where treatment for alopecia areata using diphencyprone (DCP), a contact sensitizer, has led to the development of vitiligo.
Preliminary research in animals has found that quercetin, a naturally occurring bioflavonoid found in fruits and vegetables, can protect against the development of alopecia areata and effectively treat existing hair loss.
Further research is needed, including human clinical trials, before quercetin can be considered a treatment for alopecia areata.
The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way.
While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.
Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy, a disorder characterized by a tendency to be hyperallergic, thyroiditis, and vitiligo.
Despite what many people think, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the condition, but most recent research points toward a genetic cause.
As conventional treatments for alopecia are extremely limited, studies that support natural treatments for alopecia are even thinner on the ground.
There are some people that recommend rubbing onion or garlic juice, cooled green tea, almond oil, rosemary oil, honey, or coconut milk into the scalp. While none of these are likely to cause harm, their effectiveness is also not supported by research.
Some people turn to alternative treatment methods such as acupuncture and aromatherapy, although there is little, if any, evidence to support these treatments.
The most prominent symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Any site of hair growth may be affected, though, including the beard and eyelashes.
The loss of hair can be sudden, developing in just a few days or over a period of a few weeks. There may be itching or burning in the area before hair loss. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment.
About 30 percent of individuals who develop alopecia areata find that their condition either becomes more extensive or becomes a continuous cycle of hair loss and regrowth.
About half of patients recover from alopecia areata within 1 year, but many will experience more than one episode. Around 10 percent of people will go on to develop alopecia totalis or alopecia universalis.
Alopecia areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are a number of small changes that can occur to nails:
- pinpoint dents appear
- white spots and lines appear
- nails become rough
- nails lose their shine
- nails become thin and split
Additional clinical signs include:
- Exclamation mark hairs: This occurs when few short hairs that get narrower at their bottom and grow in or around the edges of bald spots.
- Cadaver hairs: This is where hairs break before reaching the skin surface.
- White hair: This may grow in areas affected by hair loss.
Doctors are usually able to diagnose alopecia areata fairly easily by examining symptoms. They might look at the degree of hair loss and examine hairs from affected areas under a microscope.
If, after an initial clinical examination, the doctor is not able to make a diagnosis, they can perform a skin biopsy. If they need to rule out other autoimmune diseases, they might perform a blood test.
As the symptoms of alopecia areata are so distinctive, making a diagnosis is usually quick and straightforward.