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Alopecia Areata

Definition

Alopecia areata is an autoimmune disorder that causes hair loss. Alopecia areata causes the immune system to produce antibodies that attack the body's healthy hair follicles. Hair loss may be acute, or it may recur.
Hair Loss
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Causes

The cause of alopecia areata is unknown. It is likely due to a combination of genetic and environmental factors. It most typically affects patches of the scalp. Variations of alopecia areata can cause hair loss on the entire scalp, in men's beards, or over the entire body.

Risk Factors

Alopecia areata is more common in people under 30 years old. Other factors that may increase your chance of alopecia areata include:

Symptoms

Alopecia areata causes sudden, patchy hair loss. Hair loss occurs mainly on the scalp or in the beard.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. In most cases, the doctor will be able to make the diagnosis on exam. There are tests that can confirm alopecia areata or rule out other causes of your hair loss.
These tests may include:
  • Blood tests
  • Dermoscopy—to examine skin lesions with a lighted magnifier to look for fungal infections
  • Gentle pulling on the hair
  • Taking samples of scalp areas with inflammation to examine under a microscope
  • Analyzing samples of hair
  • Checking for hair loss on other parts of the body
  • Fungal culture
  • Biopsy of the scalp

Treatment

Treatment may include a waiting period. During this time, you and your doctor will evaluate your hair loss for progression or remission. Spontaneous remission occurs in nearly half of cases.
If your hair loss progresses, talk to your doctor about the best treatment plan for you. Options include:

Medications

Medications to treat alepecia areata may vary depending on your age and include:
  • Topical corticosteroids
  • Corticosteroid injections into the scalp
  • Topical medications that alter the immune system
  • Topical minoxidil
  • Antidepressants if you are also depressed

Surgery

Surgical procedures may be an option if medications do not work. Some of these include:
  • Laser therapy—To treat patches on the scalp.
  • Hair transplant—Taking hair from the back and sides of the head and transplanting it in bald areas. Hair transplant involves multiple procedures.
  • Scalp reduction with flaps—Cutting the scalp and pulling the areas with hair closer together.
  • Medical tattooing—Colored pigments are injected into the eyebrows

Other Treatments

Other ways to treat alopecia areata include:
  • Wig or hairpiece
  • Photochemotherapy —Exposure to ultraviolet light after taking topical or oral medication
  • Counseling

Prevention

There are no current guidelines to prevent alopecia areata since the cause is not known.

RESOURCES

American Academy of Dermatology http://www.aad.org

National Alopecia Areata Foundation http://www.naaf.org

CANADIAN RESOURCES

Derm Web http://www.dermatology.org

Health Canada http://www.hc-sc.gc.ca

References

Alopecia areata. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/alopecia-areata . Accessed September 20, 2013.

Alopecia areata. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated November 7, 2012. Accessed September 20, 2013.

Alopecia areata. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Alopecia%5FAreata/default.asp . Updated January 2012. Accessed September 20, 2013.

Mitchell AJ, Douglass MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985;12:644.

Price VH. Treatment of hair loss. N Engl J Med. 1999;341:964.

Rawnsley JD. Hair restoration. Facial Plast Surg Clin North Am. 2008;16:289-297.

Taylor CR, Hawk JL. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology. Br J Dermatol. 1995;133:914.

Types of hair loss. American Hair Loss Association website. Available at: http://americanhairloss.org/types%5Fof%5Fhair%5Floss/introduction.asp . Accessed September 20, 2013.

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