Alopecia Areata ("baldness in spots") is a form of hair loss from areas of
the body, usually from the scalp. Because it causes bald spots on the head
especially in the first stages, it is also called “spot baldness”.
Hair loss can extend to eyebrows, eyelashes, facial and nasal hair and create
more bald spots elsewhere in the body. Alopecia areata monolocularis describes
baldness in only one spot, alopecia areata multilocularis refers to multiple
areas of hair loss. If the patient loses all the hair on his/her scalp, the
disease is then called Alopecia areata totalis. If all body hair, including
pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.
The disease may also be limited only to the beard (alopecia areata barbae).
Alopecia areata is thought to be a minor autoimmune disease that makes the
body to treat its hair follicles as foreign tissue and suppress or stop hair
growth. It is not contagious but may be hereditary - there are a few recorded
cases of babies being born with congenital alopecia areata. Stress has not
been proven to be a crucial factor.
Diagnosis of Alopecia Areata
First symptoms are small, soft, bald patches which can take just about any
shape but are most usually round. Initial presentation most commonly occurs
in the late teenage years but can happen with people of all ages. It most often
affects the scalp but may occur any hair-bearing part of the body.
There may
be different skin areas with hair loss and regrowth in the same body at the
same time. It may go into remission for a time or permanently. The longer the
hair loss persists, the smaller the chance that it will grow back. Fingernails
may be affected, especially in severe cases where various nail changes may
appear, the most common of which would be pitting of the fingernails.
In the diagnosis of alopecia areata, exclusion of other treatable diseases
that cause hair loss such as trichotillomania and tinea capitis is important.
In trichotillomania, there may be patches of broken hair and there will not
be the skin changes associated with alopecia areata.
Treatment of Alopecia Areata
If the affected region is small, it is reasonable to observe the progression
of the illness as the problem often spontaneously regresses and the hair grows
back. In cases where there is severe hair loss, there has been limited success
treating alopecia areata with steroids (intradermal, topical or oral), other
immune modulators, minoxidil or phototherapy.
Alopecia Areata Prognosis
Effects of alopecia areata are mainly psychological (loss of self image due
to hair loss). However, patients also tend to have a slightly higher incidence
of asthma, allergies and atopic dermal ailments and even hypothyroidism. Loss
of hair also means that the scalp burns more easily in the sun. Loss of nasal
hair increases severity of hay fever and similar allergic conditions. They
may also have aberrant nail formation because keratin forms both hair and nails.
Episodes of alopecia areata before puberty predispose to recurrent episodes
after puberty. Pitting of the fingernails can hint at a more severe or prolonged
course.
Initial stages may be kept from increasing by applying topical corticosteroids.
However, since the exact mechanisms are not ultimately understood, there is
no known cure to date. Hair implants may help covering bald spots, but cannot
guarantee satisfactory outcome, since the bald areas might expand. Wigs should
be prescribed if patients, especially female patients, mention social discomfort.
