Alopecia Areata - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Alopecia Areata or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Alopecia Areata Treatment
Alopecia Areata - Overview
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.
Diagnosis
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 hair loss by up to 3 months. Hair falls out in small, round patches leaving a smooth hairless scalp in affected areas. The degree of hair loss varies from one bare patch to considerable balding.
In rare cases, the disease causes a complete loss of hair on the scalp (alopecia totalis) or total body (alopecia Universalis). Rarely, alopecia areata presents as diffuse hair loss, widespread hair loss across the scalp. On occasion, a scalp biopsy may be performed. If additional signs or symptoms are present, blood tests may reveal other autoimmune conditions.
Management
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 makeup that imitates hair and a hat may be inappropriate in a school or working environment. A wig can temporarily become necessary.
Treatment and Medication
Alopecia areata is difficult to treat and only a 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.
Topical drugs may be applied to hairless areas to stimulate hair growth. Rarely, systemic immunosuppressive treatments are used. Some people with alopecia areata try alternative treatments including acupuncture and Chinese herbs. There is no cure for alopecia areata.
Coping
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 the hair loss condition can make them feel less comfortable socializing and making friends. Contact with other sufferers or a patient support group is strongly recommended.
Prevention
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.
I have alopecia bad, and it’s hard for me to except that there’s nothing to be done. I feel unworthy I had full hair at one point and now my life is not as I would like. It only adda to my depression please give any advice to help with this issue.
I can only imagine the agony you feel about having lost your hair. Topical tofacitinib has become a game changer in the treatment of alopecia areata. Tofacitinib is a protein that regulates pathways associated with autoimmune disorders such alopecia areata. It is currently approved for treatment of another auto-immune disorder, rheumatoid arthrtis. In dermatology, we have used this medication off-label for alopecia areata for a couple of years now. and work with compounding pharmacies to make it available to our patients in a cream, lotion or gel so that systemic side effects are minimized. Please schedule a telehealth visit with Dr Hannaway or Dr Abraham to discuss your options.
do you treat scaring alopecia? my 12 year son has it
Scarring alopecia is not a common diagnosis in children, unless an infection had been present. If you are uncertain about the diagnosis, your son should be evaluated by a dermatologist. If the hair loss is indeed scarring, hair transplant is the only remedy. Unfortunately, we do not provide this service currently.
My daughter has alopecia totalis for 2 years now, we’ve been advised by costco pharmacy in Virginia that there’s a compound lab in Philadelphia that distribute a topical tofacitinib cream for all East cost. just want to check the accuracy of this information and if this is FDA approved?
You are probably referring to Chemistry Rx compounding. They can provide topical tofacitinib to those who can afford it. According to the hair experts, the long term side effect and safety profile of topical tofacitinib is much better than with its oral counterpart. There is no FDA approval for tofacitinib in alopecia areata and its use in alopcia areata is off-label at this time.
My 8 year old daughter was diagnosed with alopecia 15 months ago. She began with just a quarter size bald spot on the top of her head and then it progressed slowly over time. Over this past winter it has rapidly taken 2/3 of her hair and she has large bald spots. We see a dermatologist at Penn State Hershey Medical Center, but they only see her every 6 months. In the time we wait until the next appointment she loses more hair. She has had injections on the top of her head and we use a topical ointment on her spots. I was wondering if there are any leading doctors in the field that she could see that may be able to help her more. I was also wondering if there are any new approved treatments that have seen success. Thank you!
In addition to the hair center where you are currently treated, there is one at Upenn, at Columbia University and Umass. Tofacitinib provides excellent results in alopecia areata, especially when progressive. They are only available as systemic agents in the United States. They are not FDA approved for this diagnosis and their use in children is off label, too. Their potential long term side effects warrant very careful consideration. Clinical trials for tofactinib related agents are starting in several hair centers this summer but do not usually include children. Experimental treatment in Europe with topically compounded tofacitinib might provide the way for the future as long term side effects are expected to be reduced with this application route.
My 7 year old daughter was just diagnosed with alopecia. So far she only has one spot that is missing hair about the size of a quarter. Her doctor wants to wait to seek treatment to see if it resolves on its own. I do have a cousin who lost all of his hair as a teen and it never came back. I’m extremely nervous that the same thing will happen to her. Would you recommend seeking treatment right away or giving it some time?
Alopecia areata is a common condition in childhood, teenagers and young adults whereas alopecia totalis or universalis, as you describe in your cousin are quite rare. Most of the time alopecia areata resolves on its own without treatment within one year. I suggest minimal screening blood work for your daughter. I agree with your pediatrician to allow time to regrow hair. There is no evidence that treatment of alopecia areata can prevent alopecia totalis or universalis and treatment of her alopecia areata might only make your daughter unnecessarily self conscious about the spot.
I was diagnosed with hair loss stemming from Alopecia Areata about 4 months ago. I’ve lost most of my hair on the back of my scalp and the disease continues to be invasive. My dermatologist has put me on a combination of Betamethasone Dipropionate, Rogaine & Retin A, but the hair loss continues to advance. Are there other options such as JAK Inhibitors that might be of benefit? How could I find a doctor in the Philadelphia area that could provide consultation on these issues? My dermatologist is good, but she is a generalist and I’m looking for a specialist on Alopecia Areata in the Philadelphia area. Do you have any recommendations?
We treat patients with very similar presentations and often resort to systemic treatments when alopecia areata is rapidly progressive. If other auto-immune phenomena (thyroid related antibodies) do not require intervention, oral steroids for a brief period of time, oral cyslosporine or JAK kinase inhibitor are indicated. The latter does not yet have FDA approval for alopecia areata and is therefore not covered by insurances making this treatment extremely costly. All of us at RAD work very closely together and I recommend that you schedule an appointment, preferably with Linda Heckman, who takes care of the majority of our patients with hairloss.
What about the new FDA approved JAC inhibitors that the National Alopecia foundation has on their main page as a break through? How do you qualify to receive this drug? http://www.naaf.org/site/PageServer?pagename=research_intro
If you are a candidate for the JAK inhibitors and you cannot afford to pay for these out of pocket, your dermatologist can submit a letter of medical necessity on your behalf. It is often of great help if you submit a letter describing your sufferance alongside the letter of medical necessity. Your insurance will review the request on a case by case basis.
How close are stem cell in the fight with Alopecia areata ?
Thank you
Mr Soul
Unfortunately, it is still experimental and treatment protocols are not close to FDA approval.
I have alopecia. I’m horrified& can’t accept it at this point. Are there support groups around Bala Cynwyd PA or neighboring towns?
Unfortunately, there are no local support groups. If you have alopecia areata, the NAAF (National alopecia areata foundation) is your best resource and you may gain access to people in your area. If you suffer from androgenetic alopecia, traction alopecia or telogen effluvium, resources are more scarce. You may find support through http://www.dailystrength.org and http://www.womenshairlossproject.com.