Alopecia Areata

What is alopecia areata?

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Alopecia areata is an autoimmune disease that causes hair loss. This condition causes patches of hair to fall out in patches the shape of a quarter in various places around the body as a result of the immune system attacking hair follicles. There is currently no cure for alopecia areata. However, there are effective treatments that can help people grow their hair back. People with alopecia areata mainly experience hair loss and do not have any other symptoms or a negative impact on their overall health. 

The extent and location of hair loss varies depending on the person. Hair loss may only occur on the scalp, or it can be present on the eyelashes, eyebrows, legs, or arms. In addition, some people may be able to recover and grow their hair back while others may not be able to. Periods of hair loss may be frequent or only occur once in a while, making the condition unpredictable. 

There are three main types of alopecia areata that a person can experience. 

  • Patchy alopecia areata: partial hair loss on the scalp or body
  • Alopecia totalis: total hair loss on the scalp
  • Alopecia universalis: complete or nearly complete loss of hair on the whole body

What causes alopecia areata?

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Researchers are still studying the exact cause of alopecia areata. Since the condition is an autoimmune disease, a person’s genetic history may be the cause of the autoimmune reaction. Other causes could include non-genetic, environmental factors such as exposure to a virus or other risk factors. 

What causes the hair loss characteristic of alopecia areata is the immune system’s signal to attack hair follicles. The damaged follicles cause the hair to fall in patches. The condition does not often cause the destruction of hair follicles, meaning that hair can regrow in places where you experience hair loss. However, since alopecia areata is highly variable for each person, knowing if or when the hair will grow back is challenging. 

What are symptoms of alopecia areata?

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The primary symptom of alopecia areata is hair loss. The condition typically starts when a person loses round or oval patches of hair. Most commonly, people will lose their hair on the scalp, but alopecia areata can affect other areas of the body and sometimes multiple areas at once. The edges of the hair loss patches will have short hairs that are narrow at the base and get bigger towards the tip. There is typically no rash or redness, but some may experience a tingling, itching, or burning sensation on their skin before the hair falls. 

In some cases, people also experience changes to their nails as a result of alopecia areata. Symptoms of nail changes brought on by the condition are the formation of ridges and pits in the nails. In addition, the nails may become red and brittle. 

A person with alopecia areata usually does not develop any other symptoms and can remain healthy otherwise with no additional health complications. Over time, you may develop more patches, and some patches may grow the hair back as other patches form. In rarer cases, a person may lose all their hair from their entire head, called alopecia totalis, or entire body, called alopecia universalis.

Are there any risk factors or groups for alopecia areata?

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Alopecia areata affect all types of people and anyone can have the condition. The condition is more likely to develop during your teens, twenties, or thirties, but a person of any age can have it. 

A person’s family history and genetic makeup are the two highest risk factors for alopecia areata. People with a close family member with the disease are more likely to develop the condition themselves. While more research is needed to confirm the connection, genetics essential for immune function drive the development of alopecia areata. 

In addition to a family history of alopecia areata, people with specific autoimmune diseases are at a higher risk. In particular, the conditions of psoriasis, thyroid disease, vitiligo, Down syndrome, asthma, and seasonal allergies are linked to a higher likelihood. 

How is alopecia areata diagnosed?

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Your doctor or dermatologist will diagnose alopecia areata by conducting a physical examination of the patches of hair loss on the body. They may look closely at the patch with a microscope to examine the hair follicles to look for signs of the condition or any abnormalities. In addition, they may pull on the hairs on the perimeter of the patch to see if they fall out easily. Since alopecia areata can also cause symptoms in the nails, your doctor will likely ask to examine your nails to look for any signs of the condition. 

After a physical examination, your doctor may ask you questions about your medical and family history to understand your risk factors for the condition or if there is any familial pattern of the condition. Most of the time, an examination and questions can help your doctor confirm a diagnosis of alopecia areata. 

Because hair loss can be symptomatic of other conditions, sometimes your doctor cannot confirm an alopecia areata diagnosis. In these rarer cases, a doctor may order a skin biopsy or a blood test to rule out other conditions and make sure the alopecia areata is the source of the hair loss. These tests could indicate other immune deficiencies.

How is alopecia areata treated?

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Even though alopecia areata has no cure, there are effective treatment plans that can help you regrow hair lost to the condition and restore the health to the impacted areas of your body. The right treatment option depends on your age, the amount of hair loss you have experienced, and where you have hair loss. Together with your doctor, you can determine the best course of action for your situation. 

The main treatment for alopecia are drug therapies that are formulated for other conditions. The following list includes some of the most common treatment options. 

  • Corticosteroids: These types of drugs are anti-inflammatory medicines. Your doctor can prescribe corticosteroids as an injection, pill, or topical ointment. This treatment option can take a long time to work, and progress may be gradual. 
  • Minoxidil (Rogaine ®): Minoxidil is a topical treatment for baldness that can be effective for alopecia areata. Not all cases of alopecia areata respond to this treatment method. The full course of minoxidil is 12 weeks of treatments. 
  • Topical immunotherapy: These treatment options work by causing an allergic reaction on the skin that can cause hair growth. This option can make the skin itchy and has to be repeated to maintain the new hair growth. 

To find the right treatment plan, your dermatologist may try different options to find the one that works best for you. It is important to note that your doctor may not immediately recommend medicated treatment if you have had alopecia areata for less than a year. Within this time, your hair may grow again on its own, avoiding the need for treatment altogether. 

Should you see a doctor for alopecia areata?

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Alopecia areata generally is not an urgent condition, but if you notice symptoms of the condition, it is a good idea to schedule an appointment with your doctor to receive a diagnosis. Losing your hair in patches can be distressing and alarming, so getting reassurance from your doctor that you are not experiencing any other underlying health issues can be helpful. 

If you notice you are losing patches of hair, you should see a doctor to confirm that alopecia areata is the cause. At the time of your diagnosis appointment, your doctor may order other tests given your medical history to ensure you do not have other immune disorders or other more serious health conditions. In short, if you have symptoms consistent with alopecia areata and are concerned, you should seek a doctor. 

What is the outlook for people living with alopecia areata?

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Many people who have mild cases of alopecia areata recover fully after a few months or years. The outlook can be positive if you get the right medical attention and have regrowth. Regrowth is more likely for those who have less hair loss, are older, have no changes to their nails, and have no family history of the condition. The hair may not grow back as thick as before, but a high level of regrowth is possible. Baldness and hair loss may reappear occasionally and at random times. The more extensive the hair loss, the less likely hair will regrow fully and vice versa. 

One of the harder parts of living with alopecia areata is having permanent hair loss. Although the condition itself is not a serious risk to your health, the stigma and stress around hair loss can make the condition tough for those who have it. People struggling with these aspects of the condition can utilize makeup and wigs to help restore their appearance to their liking. In addition, support groups exist for those with the condition to connect and share encouragement. Once people with alopecia areata get on a treatment plan that works for them and start to manage their hair loss, they can live more confidently and understand their health better.