What is Alopecia Areata (AA)? AA is an autoimmune form of alopecia (hair loss) in which coin-sized patches of hair loss appear on the scalp, followed by small patches on beards and pubic hair. AA can also affect the eyebrows, eyelashes, and even body hair.
Research on AA shows that at least 20% of patients show signs of the disorder by the age of 20 years, whereas above 80% of cases are likely to experience symptoms before the age of 40 years.
AA affects all races and genders. More incidences are among African Americans than in white people. The condition is, however, more prevalent in whites than in Asians. Conclusively, the most affected group of people are African Americans, followed by white people, and finally, with fewer cases, Asians.
Note: Alopecia means hair loss, while areata means patchy.
Forms of Alopecia Areata (AA)
Forms of AA include:
- Alopecia Areata (Patchy Hair Loss)
Manifests as oval or round patches on the scalp skin or other hairy body parts.
- Alopecia Areata Totalis
Refers to when all scalp hair is lost. Most cases of AA Totalis start as patchy hair loss.
- Alopecia Areata Universalis
Commonly known as AU, this form of AA leads to hair loss on the scalp, eyelashes, eyebrows, and even the pubic area.
Patchy hair loss rarely proceeds to develop into other forms. According to past recorded cases, most people develop AA between Totalis and Universalis.
What Causes Alopecia Areata (AA)?
In most autoimmune diseases, the immune system mistakenly attacks healthy tissues, destroying them. In the case of AA, the immune system attacks healthy hair follicles and damages them. This, in turn, leads to hair loss and eventually to bald patches, as follicles can’t produce more hair.
We have yet to discover the exact cause of AA. Specialists are still trying to understand what triggers the attack on hair follicles. Some of the possible causes are:
Genetics:
AA is related to several genetic factors; however, not everybody with the specific factors develops the disorder. For some people, a genetic link to family members (especially those who experienced hair loss before the age of 30) increases the chances of AA development.
Potentially, AA might skip generations, leaving out some members of a family without the disease.
In light of recent research, 15 gene sequences referred to as gene alleles influence the cause of AA. Possessing a number of the gene alleles does not necessarily mean you will develop the AA condition. The higher the number of the 15 genes a person has, the more the chances of developing AA at some point in life.
Some of these gene sequences control:
- Hair growth
- Immune cell responses
Environment: Based on the little research on environmental triggers in AA, specialists and dermatologists suggest it is hard to generalize the idea because people react differently to environments.
Some of the factors are:
- Diets with soy oil suggested a level of connection in accelerating AA development
- Chemicals
- Microbes on the skin and gut sometimes affect immune responses, thus attacking healthy hair follicles.
- Infections such as the Epstein-Barr virus have been found in some AA patients.
Stress: Hair follicles and the skin are known to produce stress hormones. These can affect the functionality of skin immune cells or hair growth.
Hormones: Observations on several cases have linked hormonal effects to AA.
- Women in their pre-menopausal stage sometimes experience hair loss
- Pregnant women experience hair regrowth in their third trimester
Research on these observations suggests that increasing or decreasing estrogen levels may alter immunity activities.
Symptoms of Alopecia Areata (AA)
Early Symptoms
- Bald patches on the scalp
- Bald spots from conjoined patches
- Sudden loss of significant amounts of hair within a short period
Advanced Symptoms
- Hair re-growth in some areas
- Brittle and red nails
- Scalp itches
How Do You Diagnose Alopecia Areata (AA)?
Like most skin and hair conditions, AA is diagnosed by a specialist through physical examination of the scalp and affected skin on the manifesting symptoms.
A dermatologist can request a deeper examination of the hair and scalp through a biopsy, in which a strand or layer is observed under a microscope to ascertain the diagnosis.
What Treatments Are Available for Alopecia Areata (AA)?
Alopecia areata (AA) can be treated in several ways, depending on the age, extent of hair loss, and form of AA.
There is no cure for the disease; however, we have various options to manage symptoms:
Topical Therapies
- Topical corticosteroids are the most common mode of treatment for patchy AA. They manage inflammation and enhance hair regrowth, especially in children. Application is painless, and research indicates 70% regrowth after three months of treatment.
- Intralesional corticosteroids: These are injected into the bald patches to stimulate hair regrowth. This treatment has proven to be one of the most efficient, with results of up to 60% hair regrowth after 4 to 6 weeks.
- Topical contact sensitizers: This immunotherapy includes DiPhenylCyloPropenone (DPCP) treatment. DPCP is applied directly to the scalp once every week. An increased dose every week causes itching on the scalp or contact dermatitis. Dermatitis then regulates T-cell activity, reducing the chances of immune attack on hair follicles.
- Topical minoxidil: Studies show that topical minoxidil regulates enzymes that play a role in hair growth. Hair growth can be noticed within the first three months of treatment. Possible side effects include headaches and dermatitis. Once the treatment is completed, the side effects can be reversed.
- Topical retinoids: Specialists recommend that AA patients apply retinoids on the affected areas for six months, after which hair regrowth is noticeable.
Systemic Therapies
- Systemic corticosteroids: The treatment involves using oral supplements consecutively for two days every week. Prolonged use of systemic corticosteroids can result in significant side effects. Doctors recommend a treatment duration of between 1 to 6 months.
- Phototherapy: UV light therapy helps treat several skin conditions. It is, however, yet to effectively manage AA.
- Laser treatment: Excimer laser treatment is the most common, with minimal side effects.
- Miscellaneous therapies: Some agents, such as onion juice and topical azelaic acid, manage AA symptoms.
Patients taking oral or applicable medications have complained of several side effects following a few months of treatment. Recent research on the safety and tolerability of a new topical botanical formulation, GASHEE, containing over 12 phytoactive ingredients, proved effective in managing hair loss, as shown below.
Alopecia Areata (AA) Frequently Asked Question (FAQ)
Who treats alopecia areata?
Dermatologists. Ensure you consult a certified specialist to receive up-to-date treatment options.
You can complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar by using this link: https://dru.com/hair-free-consultation/
How is alopecia areata diagnosed?
Through a physical examination by a board-certified dermatologist. Get a free consultation by clicking the button below.
Learn more about hair loss conditions here.
References
Lawson, C. N., Hollinger, J., Sethi, S., Rodney, I., Sarkar, R., Dlova, N., & Callender, V. D. (2017). Updates in the understanding and treatments of skin & hair disorders in women of color. International Journal of Women’s Dermatology, 3(1 Suppl), S21–S37. https://doi.org/10.1016/j.ijwd.2017.02.006
Macbeth, A. E., Holmes, S., Harries, M., Chiu, W. S., Tziotzios, C., de Lusignan, S., Messenger, A. G., & Thompson, A. R. (2022). The associated burden of mental health conditions in alopecia areata: a population‐based study in UK primary care*. British Journal of Dermatology, 187(1), 73–81. https://doi.org/10.1111/bjd.21055
Umar, S., & Carter, M. J. (2021). A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case Reports in Dermatological Medicine, 2021, 1–12. https://doi.org/10.1155/2021/6659943
