Alopecia Areata Causes, Diagnosis and Treatments at a Glance

Alopecia areata is not a life-threatening disease; however, it triggers an alarm for affected patients, causing tremendous emotional and psychosocial distress. With its recurrent episodes of erratic, unpredictable, patchy hair loss, alopecia areata is an insidious hair disease that disrupts the life of the young and old.

What is alopecia areata?

Alopecia areata (AA) is defined as an autoimmune disease that attacks the rapidly growing cells in the hair follicles, which causes them to shrink and drastically slow down hair production. It causes hair loss in patches mostly on the scalp; however, it can occur on any other hair-growing part of the body. The condition tends to be rapid and often involves one side of the head more than the other. The distinctive bald patch seen in alopecia areata is a round and smooth patch. In odd occasions, complete loss of scalp and body hair occurs.

What causes alopecia areata?

Studies have shown that alopecia areata is an abnormality in the immune system wherein for unknown reasons the body’s own immune system attacks the hair follicles and disrupts normal hair cycle. Alopecia areata is sometimes associated with other autoimmune conditions such as allergic disorders, lupus, rheumatoid arthritis, thyroid diseases and ulcerative colitis.

Even until today, the cause of alopecia areata is still unknown. However, scientists believe that a person’s genes can certainly play a role. For people whose genes put them at risk for the disease, some type of trigger (maybe a virus or something in the person’s environment) starts the attack on the hair follicles.

According to studies, about 10 percent of patients with this condition may never regrow hair and a greater possibility of having permanent hair loss if you:

have a family history of the problematic condition;
have the condition at a younger age (before puberty);
have another autoimmune disease;
are prone to allergies (atopy);
have extensive hair loss; and
have abnormal color, texture, shape, or thickness of the fingernails or toenails.

How is alopecia areata diagnosed?

Alopecia areata is diagnosed through physical examination and a review of one’s medical history. A dermatologist can diagnose alopecia areata by looking at the hair loss condition. If the bald spot is expanding, the dermatologist will perform a skin biopsy to confirm that the disease is indeed alopecia areata. During a skin biopsy, the dermatologist removes a small piece of skin so that it can be studied under a microscope. Sometimes, a blood test may be necessary if the dermatologist thinks the patient might have another autoimmune disease.

What are some treatments of alopecia areata?

Alopecia areata cannot be “cured” but it can be treated. There are some medications that can stimulate hair regrowth. While these treatments may promote hair growth, none of them can prevent new bald patches or actually cure the underlying diseases.

A dermatologist may recommend one or more of the following treatments:

Corticosteroids — are powerful anti-inflammatory drugs similar to a hormone called cortisone which is produced naturally in the body to regulate inflammation and control auto-immune disorders and many other types of diseases. Corticosteroids may be administered for alopecia areata in three ways:

Local injections — Injections of corticosteroids directly into hairless patches on the scalp, brow, and beard areas increase hair regrowth in most cases. Typically results are not visible until roughly 1 to 2 months after the treatment. Possible side effects of using this injection might include pain, mild swelling and skin discoloration. Because injections can be painful, they may not be preferred for children.
Oral corticosteroids — These corticosteroids are taken by mouth such as prednisone. The side effects of using this treatment may include hypertensions and cataracts that is why it’s only used occasionally and within a shorter period of time.
Topical corticosteroids — Topically administered corticosteroids like creams and ointments are far less traumatic than injections, hence these are more preferred for children. However, they are less effective than injections; therefore, to improve results, these need to be combined with other topical hair loss treatments (e.g., anthralin or minoxidil).

Anthralin — is a synthetic tar-like substance available as cream or ointment which is applied daily to the scalp and washed off. It is a common treatment for psoriasis and it can also be used to treat alopecia areata. New hair growth is usually evident in 8 to 12 weeks after using this treatment.

Sulfasalazine — is a drug used to treat various autoimmune disorders such as psoriasis; however, it has been used by patients with severe alopecia areata.

Topical sensitizers — are medications that provoke allergic reactions that lead to itching, scaling, but eventually hair regrowth. New hair growth is usually established within 3 to 12 months of this treatment. Squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) are two topical sensitizers used to treat alopecia areata; however, their safety and consistency of formula are currently still under review.

Hair, Scalp and Skin Specialists