Alopecia Areata

Introduction

The usual word for hair loss is alopecia. Alopecia areata is a common reason for hair loss that doesn't leave a scar on the scalp and is capable of occurring at any age.¹ This disease, which can result in hair loss anywhere on the body, occurs when the body assaults its own hair follicles (which are structures in the skin from where hair grows).

The people who are affected by alopecia areata are otherwise healthy. Apart from hair loss, they occasionally have nail changes.²

Causes of alopecia areata

The exact causes of alopecia areata are not fully understood, but several factors are believed to contribute to the condition, including:

1. Family inheritance¹
2. Autoimmune disorders: The body's immune system mistakenly attacks hair follicles, causing them to shrink and resulting in hair loss^1,2
3. Environmental factors: Exposure to certain environmental factors, such as viral infections or toxins, may trigger an autoimmune response in people with a genetic predisposition to alopecia areata³
4. Psychological factors: Stress, anxiety, and other psychological factors may also play a role in the development of alopecia areata^1,3
5. Hormonal imbalances: Changes in hormone levels, such as those that occur during puberty, pregnancy, or menopause, may contribute to the development of alopecia areata³
6. Medications: Certain medications, such as those used to treat cancer or autoimmune disorders, may cause hair loss as a side effect^2,3

Symptoms of alopecia areata

The main symptom of alopecia areata is patchy hair loss, which can occur on the scalp, face, and other areas of the body. The hair loss usually appears as one or more small, round, or oval patches, and it may progress to involve larger areas of the scalp or body.

Other symptoms of alopecia areata include:

1. Exclamation mark hairs are short, broken hairs that taper at the base and are often found at the edges of bald patches³
2. Cadaver hairs are hairs that break before reaching the skin's surface¹
3. Nail changes: Rough, pitted, or ridged nails, or nails that are thin or split, may occur in some people with alopecia areata^1,2
4. Itching or burning: Some people with alopecia areata may experience itching or burning in the affected areas²
5. Regrowth: Hair may regrow on its own in some people with alopecia areata, but it may also fall out again later³
6. Emotional distress: Hair loss can be emotionally distressing and impact a person's self-esteem and quality of life³

Types of alopecia areata

Patchy alopecia areata

This is the most common form of alopecia areata, and it is characterized by one or more coin-sized bald patches on the scalp or other parts of the body.¹

Totalis alopecia areata

This type causes total baldness since all of the hair on the scalp is lost.^1,3

Universalis alopecia areata

This is the most severe form of alopecia areata, and it involves the loss of all body hair, including eyebrows, eyelashes, and pubic hair.³

Diagnosis

The diagnosis of Alopecia Areata can be made by the following:

Physical examination:

The presence of smooth bald patches, broken hairs, or swollen hair follicles can be seen. Moreover, according to the patient's medical history, including any recent illnesses or medications, family history of autoimmune disorders or hair loss, and stress levels.¹

Biopsy: 

A scalp/skin biopsy can be done to rule out the other diseases.³

Blood Tests: 

A blood test is done to rule out the other autoimmune condition or any other reason behind the hair loss.^1,3

Treatment 

The treatment of Alopecia Areata includes : 

1. Corticosteroids: They can be applied topically as a cream or lotion or injection into the scalp or affected areas^1,3
2. Minoxidil
3. Topical immunotherapy: This involve applying a chemical to the affected areas to cause an allergic reaction, which can stimulate hair growth¹
4. Anthralin^1,3
5. JAK Inhibitors (Janus Kinase Inhibitor)¹
6. Hair transplantation^1,3
7. Hairpiece or wig^1,3
8. Methotrexate^1,3

Complications

Alopecia areata is generally not a life-threatening condition. Some potential complications associated with alopecia areata include:

Psychological effects 

Hair loss can have a significant impact on a person's self-esteem and mental health, leading to feelings of anxiety, depression, and social isolation.

Skin infections

In rare cases, bacterial or fungal infections can occur in areas of hair loss, particularly if the skin is broken or irritated.

Sunburn

Hair provides a natural barrier against the sun's harmful UV rays. People with alopecia areata may be more susceptible to sunburn and skin damage, particularly on the scalp or other exposed areas.

Prevention and coping

There is no known prevention for alopecia areata. However, there are some steps that people with alopecia areata can take to manage their condition and cope with the emotional and psychological effects of hair loss:

1. Seek support: Hair loss can be a difficult and emotional experience. It's important to seek support from loved ones, friends, or a mental health professional to help manage the emotional impact of hair loss
2. Consider hair pieces or wigs
3. Protect exposed areas: If hair loss is extensive or affects the scalp, it's important to protect the exposed areas from sunburn and skin damage by wearing a hat or applying sunscreen.
4. Manage stress
5. Follow medical advice

Summary

Alopecia areata is a common immune-mediated disease that attacks the hair follicles and causes severe hair loss on the scalp or elsewhere in the body. It is generally characterised by round or oval patches. It is commonly associated with other autoimmune disorders such as thyroiditis and vitiligo, as well as asthma, allergic rhinitis, etc. Sometimes, nail abnormalities such as ridges and pits might be seen. The causes of alopecia areata can include family inheritance, environmental factors, psychological factors like anxiety, and certain medications. A biopsy, a physical examination, and blood testing can all be used to make a diagnosis. Although alopecia areata can be treated with corticosteroids,minoxidil, and anthralin, However, the possibility of a recurrence exists.