Alopecia areata is an autoimmune disorder that usually results in unpredictable, patchy hair loss. Approximately 7 million people in the U.S. have alopecia …
Alopecia areata (AA) is a condition affecting humans, in which hair is lost from some or all areas of the body, usually from the scalp. Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In 1%–2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia Universalis). Conditions resembling AA, and having a similar cause, occur also in other species.
The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.
- Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.
- Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
- Alopecia areata multilocularis refers to multiple areas of hair loss.
- The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.
- If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
- If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata Universalis.
Alopecia areata totalis and universalis are rare.
Signs and symptoms
The first symptoms are small, soft, bald patches which can take just about any shape but are most usually round. It most often affects the scalp and beard but may occur on any hair-bearing part of the body. There may be different skin areas with hair loss and regrowth in the same body at the same time. It may also go into remission for a time, or permanently.
The area of hair loss may tingle or be very slightly painful.
The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.
Another presentation of the condition is exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic “exclamation point” appearance.
In the case of healthy hair, if you were to try to pull some out, none should fall out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body’s immune system than away from the patch where they are still healthy.
Nails may have pitting or trachyonychia.
Patients with alopecia can sometimes present with Ciceromegaly, which is characterized by short stature, hair loss, and hypogonadism.
Alopecia areata is noncommunicable, or not contagious. It occurs more frequently in people who have affected family members, suggesting that heredity may be a factor. Strong evidence that genes may increase the risk for alopecia areata was found by studying families with two or more affected members. This study identified at least four regions in the genome that are likely to contain alopecia areata genes. In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.
The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth. There is evidence that T cell lymphocytes cluster around these follicles, causing inflammation and subsequent hair loss. An unknown environmental trigger such as emotional stress or a pathogen is thought to combine with hereditary factors to cause the condition. There are a few recorded cases of babies being born with congenital alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system.
If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair may grow back.
In cases where there is severe hair loss, there has been limited success in treating alopecia areata with clobetasol or fluocinonide, steroid injections, or cream. Steroid injections are commonly used in sites where there are small areas of hair loss on the head or especially where eyebrow hair has been lost. Some other medications used are minoxidil, Elocon ointment (steroid cream) irritants (anthralin or topical coal tar), and topical immunotherapy cyclosporine, each of which is sometimes used in different combinations.
Oral corticosteroids decrease hair loss, but only for the period during which they are taken, and these drugs have adverse side effects.
For small patches on the beard or head, it is possible to suppress with topical tacrolimus ointments like Protopic. Symptoms may remain suppressed until aggravated by stress or other factors.
Initial stages may be kept from increasing by applying topical corticosteroids. However, topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.
In terms of adapting to the disease rather than treating it in an effort to cure it, there are also many options available. Wigs are often used by those with Alopecia, particularly Alopecia Totalis, in which hair is entirely lost from the scalp. Wigs are available at many levels of development and technology, including wigs with suction mechanisms to keep them firmly attached to the scalp.
In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia totalis or, in rare cases, Universalis.
Effects of alopecia areata are mainly psychological (loss of self-image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies, atopic dermal ailments, and even hypothyroidism. Loss of hair also means that the scalp sunburns more easily. Loss of nasal hair increases the severity of hay fever and similar allergic conditions. Patients may also have aberrant nail formation because of keratin forms both hair and nails.
Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, however, but rather a natural cycle of growth-and-shedding from a relatively synchronized start; such a pattern will fade over time. Episodes of alopecia areata before puberty predispose one to the chronic recurrence of the condition.
Psychosocial issues: Alopecia can certainly be the cause of psychological stress. Because hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression.
The condition affects 0.1%–0.2% of humans, occurring in both males and females. Alopecia areata occurs in people who are apparently healthy and have no skin disorder. Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages.
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