Alopecia areata is a disorder that affects hair follicles and is reflected in round patches of hair loss. Normally, the immune system functions to protect the body against infection and disease. In alopecia areata, the body’s immune system mistakenly recognizes hair follicles as foreign and attacks them. The cause is not known, but the prevailing scientific hypothesis is that genetics plays a significant role in predisposition and a trigger initiates the attack on the hair follicles.
Alopecia areata often begins in childhood. The risk is significantly increased if you have a close family member afflicted with the disease. Emotional or physical trauma typically precedes the hair loss by up to 3 months. Hair falls out in small, round patches leaving a smooth hairless scalp in affected areas. Degree of hair loss varies from one bare patch to considerable balding. In rare cases, the disease causes complete loss of hair on the scalp (alopecia totalis) or total body (alopecia universalis). Rarely, alopecia areata presents as diffuse hair loss. On occasion, a scalp biopsy may be performed. If additional signs or symptoms are present, blood tests may reveal other autoimmune conditions.
In most instances, the hair regrows spontaneously; however, this process takes several months. When alopecia areata is located on the scalp and cannot easily be hidden by covering hair or clever hairstyles, the psychological impact of alopecia areata can be severe. There is no make up that imitates hair and a hat may be inappropriate in a school or working environment. A wig can temporarily become necessary.
Alopecia areata is difficult to treat and only few treatments have been assessed in randomized controlled trials. The most common treatments seem to facilitate faster regrowth of hair rather than treat the underlying problem. Typical therapy includes topical corticosteroids, steroid injection under the skin surface, and ultraviolet light therapy, especially narrowband UVB. Irritating drugs may be applied to hairless areas to stimulate hair growth. Rarely, systemic immune suppressive treatments are indicated. Some people with alopecia areata try alternative treatments including acupuncture and Chinese herbs. There is no cure for alopecia areata.
Many are profoundly upset by their hair loss and some may require psychological support. It might be difficult to cope with relapse following or during initially successful treatment. These considerations are particularly important in children, as social disruption and focusing of the child's attention on their hair loss may result from active treatment. Contact with other sufferers or a patient support group is strongly recommended.
When emotional stress is the known trigger, efforts should be made to redirect or avoid these stressors. Some may do well with biofeedback training, mediation or Yoga; others will find their own way of coping with these stressors.
General considerations to keep your hair healthy and minimize the appearance of hair loss include a nutritionally balanced diet; and gentle handling of your hair. Whenever possible, allow your hair to air-dry naturally; avoid tight hairstyles, such as braids, buns or ponytails; and avoid compulsively twisting, rubbing or pulling your hair.
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