Alopecia areata:
Causes, diagnosis and treatments
Alopecia areata is an autoimmune disorder
that can lead to unpredictable hair loss. Scientist believe the cause is
genetic, as it tends to run in families.
Alopecia areata is a common autoimmune disorder that often
results in unpredictable hair loss.
It affects roughly 147 million people worldwide.
In most cases, hair falls out in small patches around the size
of a quarter. There may be only a few patches, but alopecia areata can affect
wider areas of the scalp.
If there is a complete loss of hair on the scalp, doctors
diagnose alopecia totalis. If there is hair loss throughout the entire body,
the condition is called alopecia universalis.
Alopecia can affect anyone, regardless of age, gender, or race,
though most cases develop before the age of 30.
In this article, we look at the causes and symptoms of alopecia
areata, its diagnosis, and potential treatments.
There is currently no cure for alopecia areata, although there
are some forms of treatment that can be suggested by doctors to help hair
re-grow more quickly.
The most common form of alopecia areata treatment is the use of
corticosteroids, powerful anti-inflammatory drugs that can suppress the immune
system. These are mostly commonly administered through local injections,
topical ointment application, or orally.
Other medications that can be prescribed that either promote
hair growth or affect the immune system include Minoxidil, Anthralin, SADBE,
and DPCP. Although some of these may help with the re-growth of hair, they
cannot prevent the formation of new bald patches.
The use of photochemotherapy is supported by some
studies and presents a potential alternative for patients unable or unwilling
to use systemic or invasive therapies.
In addition to its aesthetic aspect, hair affords a degree of
protection against the elements. People with alopecia areata who miss the
protective qualities of hair may wish to:
- Wear sunscreen if exposed to the sun.
- Wear wraparound glasses to protect the eyes from the
sun and debris which the eyebrows and eyelashes would normally defend
against.
- Use headwear such as hats, wigs, and scarves to protect
the head from the sun or keep it warm.
- Use ointment inside the nose to keep membranes moist
and to protect against organisms that are normally trapped by nostril
hair.
Alopecia areata does not directly make people sick, nor is it
contagious. It can, however, be difficult to adapt to emotionally. For many
people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of
hair loss, as well as the hair loss itself.
Support groups and counseling are available for people to share
their thoughts and feelings, and to discuss common psychological reactions to
the condition.
Some have compared alopecia areata to vitiligo, an autoimmune skin disease in which the body attacks
melanin-producing cells, leading to white patches. Research suggests that these
two conditions may share a similar pathogenesis, with similar types of immune
cells and cytokines driving the diseases and common genetic risk factors.
As such, any new developments in the treatment or prevention of
either disease may have consequences for the other.
There have been a handful of documented cases where treatment
for alopecia areata using diphencyprone (DCP), a contact sensitizer, has led to the development of
vitiligo.
Preliminary research in animals has found that quercetin, a
naturally occurring bioflavonoid found in fruits and vegetables, can protect
against the development of alopecia areata and effectively treat existing hair
loss.
Before people can consider quercetin a treatment for alopecia areata, scientists need to do
more research.
Causes
The condition occurs when white blood cells attack the cells in
hair follicles, causing them to shrink and dramatically slow down hair
production. It is unknown precisely what causes the body’s immune system to
target hair follicles in this way.
While scientists are unsure why these changes occur, it seems
that genetics are involved as alopecia areata is more likely to occur in a
person who has a close family member with the disease. One in five people with
the disease has a family member who has also developed alopecia areata.
Other research has found that many people with a family history of
alopecia areata also have a personal or family history of other autoimmune
disorders, such as atopy, a disorder characterized by a tendency to be
hyperallergic, thyroiditis,
and vitiligo.
Despite what many people think, there is very little scientific
evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the
condition, but most recent research points toward a genetic cause.
Research data on race and ethnicity
In the past, people believed that alopecia areata occurred equally across all races, but more recent studies suggest
that this may not be true.
For example, some findings suggest that
African Americans and Hispanic females have a greater lifetime occurrence of
the condition, when compared with white females. Additionally, there is a lower
risk in Asian people, compared with white people.
According to a 2019 study based on an analysis of over 11,000
cases in the National Alopecia Areata Registry between 2000 and 2016, the odds
ratios of an alopecia areta diagnosis for People of Color when compared to
white people.
- 1.77 for African
American people
- 1.27 for other
races, including Native Americans and Pacific Islander people
- 1 for white
people
- 0.9 for Hispanic
people
- 0.4 for Asian
people
Based on a 2018 cross-sectional analysis from the Nurses’
Health Study (NHS) and Nurses’ Health Study II (NHSII) of over 1,100 women who
reported a diagnosis of alopecia areata, compared to 1.00 odds for white women,
the odds for a diagnosis for Black women were 2.72 per the NHS and 5.48 per the
NHSII.
For Hispanic women, the odds were 1.94 compared to white women,
based on the NHSII. There were no significant incidence differences based on
the NHS.
But only a few studies have examined the patterns and
determinants of alopecia, and pathophysiological factors are largely
unexplored. Further research is warranted that takes into consideration
environmental, behavioral, genetic, and socioeconomic factors as well as access
to healthcare.
Home
remedies
As conventional treatments for alopecia are extremely limited,
studies that support natural treatments for alopecia are even thinner on the ground.
There are some people that recommend rubbing onion or
garlic juice, cooled green
tea, almond oil, rosemary oil, honey, or coconut milk into the
scalp. While none of these are likely to cause harm, research does not support
their effectiveness.
Some people turn to alternative treatment methods such as acupuncture and
aromatherapy, although there is little, if any, evidence to support these
treatments.
Symptoms
The most prominent symptom of alopecia areata is
patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the
scalp. Any site of hair growth may be affected, though, including the beard and
eyelashes.
The loss of hair can be sudden, developing in just a few days or
over a period of a few weeks. There may be itching or burning in the area
before hair loss. The hair follicles are not destroyed and so hair can re-grow
if the inflammation of
the follicles subsides. People who experience just a few patches of hair loss
often have a spontaneous, full recovery without any form of treatment.
About 30 percent of individuals who develop alopecia areata find
that their condition either becomes more extensive or becomes a continuous
cycle of hair loss and regrowth.
About half of patients recover from alopecia areata within 1
year, but many will experience more than one episode. Around 10 percent of
people will go on to develop alopecia totalis or alopecia universalis.
Alopecia areata can also affect the fingernails and toenails,
and sometimes these changes are the first sign that the condition is
developing. There are a number of small changes that can occur to nails:
- pinpoint dents
appear
- white spots and
lines appear
- nails become
rough
- nails lose their
shine
- nails become
thin and split
Additional clinical signs include:
- Exclamation mark
hairs: This occurs when few short hairs that get narrower at their bottom
and grow in or around the edges of bald spots.
- Cadaver hairs:
This is where hairs break before reaching the skin surface.
- White hair: This
may grow in areas affected by hair loss.
Doctors are usually able to diagnose alopecia areata fairly
easily by examining symptoms. They might look at the degree of hair loss and
examine hairs from affected areas under a microscope.
If, after an initial clinical examination, the doctor is not
able to make a diagnosis, they can perform a skin biopsy. If they need to rule
out other autoimmune diseases, they might perform a blood test.
As the symptoms of alopecia areata are so distinctive, making a
diagnosis is usually quick and straightforward.
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