Alopecia

What is alopecia?

Alopecia areata is an autoimmune condition that affects the hair follicles. A person with alopecia will experience widespread hair loss. Alopecia can affect all hair follicles, including the scalp, eyebrows, the face, eyelashes, and other places on the body. This condition often takes years to develop, and many patients experience periods of “remission” between bouts of hair loss.

Alopecia is a very common disease. It affects around 7 million people in the United States alone, and people of all sexes, ages, and ethnicities are at risk. However, most people with alopecia are generally otherwise healthy. While the symptoms of the condition may look concerning, the disorder is itself not a sign of a life-threatening illness.

There are no known alopecia cures, but there are a variety of treatments available to facilitate hair growth and improve a person’s confidence. While alopecia is not itself dangerous, patients with the condition often struggle with self-confidence and symptoms of anxiety. If you are interested in addressing your alopecia, schedule an appointment with a dermatologist. Only a professional can provide a diagnosis and recommend a personalized treatment plan.

What causes alopecia?

Alopecia is an autoimmune condition. This means the body’s immune system attacks the body itself, mistaking healthy cells for foreign bodies. In the case of alopecia, the hair follicles are the target of the immune system attack. As the follicles become smaller and less abundant, they stop producing hair. This, in turn, leads to patchy or widespread baldness.

As with many autoimmune conditions, doctors are unsure of alopecia’s exact cause. However, there are several risk factors that appear to contribute to the likelihood of developing the disease. These alopecia risk factors include:

• Vitamin D Deficiency: Patients with alopecia are more likely to have a deficiency in vitamin D. This vitamin helps the body to absorb and retain both phosphorous and calcium.
• Genetics: If you have a close family member with alopecia, you are more likely to develop the condition.
• Concomitant Health Conditions: People with vitiligo, thyroid disease, and Down’s Syndrome are more likely to experience alopecia.

Additionally, alopecia tends to be more common in people with melanated skin, particularly those of African descent. As is the case with other autoimmune conditions, people assigned female at birth are also more likely to develop alopecia. While these trends are visible in the research, few physicians have examined the condition’s exact pathology. This means that, while there are certain trends and patterns in who has or develops alopecia, there is little information about why the condition is common in those populations.

What are the symptoms of alopecia?

Hair loss is the most visible and widely experienced symptom of alopecia. In most cases, hair loss develops in patches. Some patients may see regrowth every few months, but additional bare patches may develop. Over time, small patches of hair loss can join with other to form larger swaths of baldness.

Hair loss typically begins as clumps of hair left places around the house, such as in the shower or on a pillow. People may also experience changes to the hairs themselves. For example, “exclamation mark” hairs may become more common. These hairs narrow at the base, indicating a problem with the follicle. Additionally, people with alopecia may experience “cadaver” hairs. This occurs when hairs grow but break before reaching the surface of the skin. Alopecia may also result in sparse white hairs the grow in bald patches.

Additionally, people with alopecia may experience changes to their fingernails and toenails. Ridges, pits, peeling, and splits may occur in the nail beds. In some cases, changes to the nails may be the first sign of alopecia. The risk of nail changes often correlates with the severity of the disease itself.

Are there different types of alopecia?

Yes, there are several types of alopecia. The type of alopecia with which a person is diagnosed will depend on its location, characteristics, and auxiliary symptoms. Here are the five most common types of alopecia.

• Alopecia areata: This type of alopecia is known to be “patchy.” It primarily presents with small, coin-sized patches of baldness, which can appear anywhere on the body. As the disease progresses, alopecia areata may transition into alopecia totalis or alopecia universalis.
• Alopecia totalis: Unlike Alopecia areata, alopecia totalis affects the entire scalp. It is characterized by widespread hair loss on a person’s head.
• Alopecia universalis: Alopecia universalis describes alopecia that has affected all parts of the body. It causes hair loss all over the body, often in totality.
• Ophiasis alopecia: In this rare type of alopecia, the patient experiences hair loss in a band that stretches from the sides to the back of the scalp.
• Diffuse alopecia areata: This type of alopecia presents as typical male- or female-pattern hair loss. In patients with diffuse alopecia areata, sudden hair loss and thinning occurs.

The treatment your doctor recommends will rely on the type of alopecia with which you are diagnosed. If you are experiencing hair loss and are unsure why, schedule an appointment with a dermatologist. Receiving a proper diagnosis is the first step toward treatment.

How is alopecia diagnosed?

Most doctors will diagnose alopecia after observing the extent of an individual’s hair loss. In many cases, a doctor may examine hair samples under a microscope to examine the follicle. Doctors may also order a biopsy of the scalp to help rule out other conditions that may cause hair loss, like fungal infections.

If a doctor suspects other autoimmune conditions, they may order a range of blood tests. While these tests will vary based on what other autoimmune condition you may have, their primary function is to check for abnormal antibodies. These abnormal antibodies are a tell-tale sign of an autoimmune condition.

While most people won’t need a doctor to tell them they have hair loss, a diagnosis can provide peace of mind. If you suspect you have alopecia, connect with a dermatologist. They can diagnose and facilitate personalized treatment depending on your specific needs.

Are there any alopecia treatments?

While there are no known alopecia cures, there is a wide variety of treatment options to help slow the condition or restore the follicles after hair loss. Keep in mind that most treatments are highly personalized; what works for one person might not work for another. Addressing hair loss often comes with a lot of trial and error. If a certain treatment does not work for you, move to the next best option. Here are some of the most common treatments for alopecia:

• Immunosuppressants: These medications, which include cyclosporine and methotrexate, can block the immune system’s attacks on the body. However, immunosuppressants cannot be used for long periods of time.
• Steroid Injections: This is a common treatment for mild and patchy hair loss. In this treatment, a doctor will inject a steroid into the bald area every 1 or 2 months to facilitate hair growth.
• Cortisone Tablets: Doctors may sometimes prescribe oral cortisone to treat hair loss. However, because of the risk of side effects, this is not an adequate long-term solution.
• Rogaine: Known medically as minoxidil, Rogaine is available over the counter. Rogaine is not FDA approved for alopecia areata, so we recommend seeking approval from a healthcare professional – especially before applying the cream to sensitive areas.
• Corticosteroids: Steroid creams, lotions, ointments, and foams can help decrease inflammation in the hair follicle, thus making growth easier.
• Laser Therapy: Laser and light therapy, known as photochemotherapy, deploys specific ultraviolet light wavelengths to encourage new hair growth.
• Skin-Irritating Therapies: Certain drugs, like anthralin and diphencyprone, are applied to the skin specifically to cause an allergic rash. These rashes can spur new hair growth, but they are often unpleasant.
• Olumiant: The FDA recently approved baricitinib oral tablets to treat severe alopecia in adults. This medication was originally formulated as a treatment for rheumatoid arthritis.

In addition to these treatments, some doctors advise patients to improve health in other areas of their lives. For example, many people believe that following an anti-inflammatory diet, such as the Mediterranean diet or FODMAP diet, can reduce the body’s autoimmune response.

What is the outlook for people with alopecia?

While alopecia itself is not a dangerous health condition, it can severely affect a person’s self-confidence and outlook. Hair loss, especially at an early age, can be emotionally challenging. For people struggling with an alopecia diagnosis, the National Alopecia Areata Foundation facilitates support group meet-ups around the country. Alopecia is an extremely common condition, and being in community with other people can improve an individual’s quality of life.

Physiologically, alopecia prognoses are highly individualized and different for each patient. Some individuals will experience auxiliary autoimmune symptoms. However, there are certain strategies to combat the emotional challenges that come with widespread hair loss. For example, microblading, a form of tattooing, can restore the look of eyebrows. Eyelash extensions can restore eyelashes. For people with baldness, wigs can provide a much-needed source of confidence. Depending on how alopecia affects your life, there are a number of ways to improve your experience of the world.