For many of us, hair plays a central role in self-expression and self-esteem, and the impact of losing hair can be immense. Ophiasis alopecia is an uncommon variation of alopecia areata, an autoimmune disorder that causes localised hair loss. Ophiasis alopecia creates a distinct pattern of hair loss along the sides and lower back of your head in the shape of bands.¹ Due to its snake-like wavy band pattern, hair loss is more difficult to manage and may be quite distressing because it is more obvious and difficult to hide. Furthermore, this condition can have a significant psychological impact and cause mental stress. Additionally, the poor prognosis of ophiasis alopecia, combined with its resistance to treatment and frequent relapses, makes managing the condition particularly challenging.² Therefore, it is crucial to accurately and timely diagnose this condition for its effective treatment. In this article, we will explore the treatment options available for ophiasis alopecia.

Understanding ophiasis alopecia

Ophiasis alopecia is a rare and specific subtype of alopecia areata, affecting only around 0.02% of people.² Although it can appear at any age, children and infants are most frequently affected by ophiasis alopecia, which frequently manifests before puberty.²

This condition leaves a bald band, which is often wavy but can occasionally be straight on the back and sides of your head. It is occasionally referred to as occipital alopecia since it generally affects the occipital region of your scalp.²

Causes

Although the exact cause is not yet understood, it is believed that the cause is similar to that of other kinds of alopecia areata. Ophiasis alopecia is an autoimmune disorder. It occurs when your hair follicles are wrongly recognised as foreign harmful invaders by the immune system. As a result, these hair follicles become targets for immune cell attacks, which affects hair growth and causes hair loss.² Although the exact mechanism of the immunological attack on hair follicles is unknown, experts do think that both hereditary (run in families) and environmental factors like high stress are involved.³

Symptoms

• The main symptom is hair shedding in a wavy band pattern that resembles a snake
• Changes to the nail– these might include white spots, lines, or a loss of shine, as well as variations in the colour and texture of your nails
• Nail thinning– both fingernails and toenails thinning might be early warning indicators
• Hair texture– in the affected areas, hair appears finer, tiny, and thinner compared to the thick, lengthy hair in unaffected parts⁴

Treatments for ophiasis alopecia

While treatment can effectively manage this condition, in some cases, ophiasis alopecia resolves on its own at around 15-20 months without any treatment. However, the regrowth of this hair is rarely permanent. So after a while, you could anticipate a return of the hair loss. Treatment of this condition helps promote some regrowth of hair. In other cases, ophiasis alopecia may never fully go away because there is no recognised therapy for it, and it frequently becomes resistant to it.² However, there are several medications and treatments that can lessen the symptoms and help people regain some of their hair.

Minoxidil

It is a popular over-the-counter drug which is effective for hair growth. It usually comes in foam, liquid, and cream forms. Hair growth may be aided by applying minoxidil to the afflicted regions. However, one needs to be mindful as it may take the medicine anywhere from six months to a year to start working. For certain people, ophiasis alopecia may require a longer wait and patience since it may not react to minoxidil rapidly.⁴ It is always crucial to speak with your physician before using minoxidil to treat ophiasis-related alopecia.

Corticosteroids

Another widely used drug to treat ophiasis alopecia is corticosteroids. They have the ability to reduce inflammation and can aid in reducing the immune system attack. These are available as injections and topical ointments.⁴

Topical triamcinolone acetonide 0.1% lotion is a widely used corticosteroid. For example, in a four-month-old female infant with ophiasis alopecia areata, the use of topical triamcinolone acetonide 0.1% lotion was applied twice daily to the affected areas, resulting in noticeable hair regrowth after six weeks.⁵ Another study also reported treatment success with topical minoxidil and intralesional injection of triamcinolone acetonide 0.1%.⁶

Platelet-rich plasma (PRP) therapy

In this treatment approach, the patient's blood is drawn, and the platelets (a kind of blood cell) are separated and extracted from the blood. These platelets are then injected back into the scalp's hair-loss regions for hair growth. These platelets help the hair follicles to produce new hair by stimulating the natural healing mechanism of your body.²

For example, PRP therapy was conducted on a 41-year-old woman who had not reacted to topical steroids and minoxidil therapy in the past. The findings revealed that PRP therapy was effective in encouraging hair growth in a patient after three months of administration.⁷

Microneedling

Microneedling (derma rolling) is a treatment that involves making small punctures in your scalp with a device called a derma roller. This process helps hair growth medications to penetrate the skin more deeply and sets off your body's natural healing response.²

For example, a study conducted on a 58-year-old man with ophiasis alopecia showed significant improvement using microneedling combined with topical clobetasol treatment. The patient had experienced abrupt hair loss, particularly on the left side of his scalp. After six months of treatment with twice-daily clobetasol and microneedling treatments, his hair had grown back almost completely. This was due to the direct delivery of medication through microneedling to the areas of inflammation. The findings indicate its potential for ophiasis alopecia due to its effectiveness and minimal side effects.⁸

Dupilumab

Dupilumab is a monoclonal antibody which acts by blocking specific proteins in the body that cause inflammation, particularly interleukin-4 (IL-4) and interleukin-13 (IL-13). Dupilumab reduces the immune response in ophiasis alopecia by reducing inflammation and encouraging hair growth.⁹

The potential of dupilumab as a therapy for ophiasis alopecia was investigated in a case study. The patient, a 33-year-old woman, began receiving dupilumab injections and after two weeks, she showed improvement in her hair growth. The medication was discontinued after six months of treatment, when the patient's hair regrowth was almost complete. But around six months later, fresh hair loss was seen, so the medication was restarted.⁹

Diphenylcyclopropenone (DPCP) 

Diphenylcyclopropenone (DPCP) is a topical immunotherapy agent primarily used to treat alopecia areata. It works by inducing a localised allergic reaction on the scalp, which stimulates the immune system to target the underlying autoimmune processes responsible for hair loss.

A study assessed the effectiveness of topical immunotherapy with diphenylcyclopropenone (DPCP) in four patients with ophiasis alopecia. The patients had suffered from this condition for 1 to 6 years and had not responded to previous treatments. After sensitisation with DPCP, the patients applied progressively higher concentrations weekly for six months. Three out of four patients achieved significant hair regrowth. DPCP is noted for its safety and stability compared to other treatments.¹⁰ 

Hair transplantation

In all the cases of ophiasis alopecia, medical treatment may not always aid in hair growth. Under such circumstances, deciding on hair restoration techniques such as complete hair transplantation might be a wise choice. In this technique, little hair patches from the undamaged sections of the scalp are taken out and replanted on the afflicted areas.⁴

How to prevent ophiasis alopecia?

Unfortunately, because ophiasis alopecia is predominantly a genetic autoimmune illness, there is no known prevention to avoid it. However, you could delay its development by consuming a diet rich in anti-inflammatory foods and having a strong immune system. There is still more research to be done on the connection between nutrition and autoimmune diseases, but some evidence suggests that diet may be able to prevent alopecia areata. A balanced diet rich in vitamins, including vitamin D, antioxidants, and omega-3 fatty acids, can help maintain a healthy scalp and hair. Foods like salmon, blueberries, and broccoli are excellent choices for your diet.¹¹

Summary 

Ophiasis alopecia is a rare autoimmune subtype of alopecia areata that causes hair loss in a wavy band pattern around the sides and back of the head. It is mainly found in children, although people of all ages can be affected. This condition occurs when your immune system mistakes your hair follicles as foreign invaders and attacks them. Treatment involves the use of corticosteroids and minoxidil, as well as microneedling. Other approaches are platelet-rich plasma treatment, treatment using topical immunotherapy agents like DPCP, and monoclonal antibodies like dupilumab. In cases where the treatment doesn't result in any improvements, hair transplantation could be done. Apart from treatment, prevention strategies like following a balanced diet and thereby maintaining the immune system can also help reduce the progression.