Alopecia areata, also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body. Usually, the hair loss occurs from the scalp due to the body’s failure to recognize its own body cells and subsequent destruction of its own tissue as if it were an invader.
It usually causes small, coin-sized, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes, body, and limbs can be affected. Occasionally it can involve the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia universalis). It is not possible to predict how much hair will be lost. Regrowth of hair in typical alopecia areata is usually over a period of months or sometimes years, but cannot be guaranteed. The hair sometimes regrows white, at least in the first instance. Further hair loss is not uncommon. In alopecia totalis and alopecia universalis, the likelihood of total regrowth is less.
Alopecia areata (patchy) is the form with one or more coin-sized (usually round or oval) patches on the scalp or other places on the body that grow hair. This type may convert into either alopecia totalis (hair loss across the entire scalp) or alopecia universalis (hair loss across the entire body), but most commonly it remains patchy.
Persistent patchy alopecia areata
Persistent patchy alopecia areata is characterized by patchy scalp hair loss that continues over a long period of time without ever developing into extensive alopecia areata such as totalis or universalis.
Alopecia totalis results in hair loss across the entire scalp.
Alopecia universalis is more advanced than alopecia totalis. This type results in hair loss across the entire scalp and face (including eyebrows and eyelashes), plus the rest of the body (including pubic hair).
Other forms of alopecia areata
Diffuse alopecia areata results in sudden and unexpected thinning of the hair all over the scalp. It can be hard to diagnose because it looks a lot like other forms of hair loss such as telogen effluvium or male or female pattern hair loss.
Ophiasis alopecia areata has a unique pattern of hair loss, which includes the sides and lower back of the scalp (called the occipital region) in the shape of a band. Ophiasis alopecia areata can be more difficult to treat because it does not respond as quickly to medication.
Hair care and styling: Use of the harsh chemical through shampoos, hair coloring products or hair styling habits like using hair dryers can also increase the likelihood of Alopecia since these are found to be stressful to your hair & scalp.
Stress: Any exposure to unusual stressful factors like extreme weather conditions, etc. Emotional stress leading to use of anti-depressants or other medication increase the probability of getting Alopecia disorder.
Vaccination: Sometimes, particularly in children Alopecia is seen to develop post vaccination.
Viral infections: Viral infections can trigger alopecia areata.
Vit D deficiency: A study confirms that individuals with low levels of Vit D are at high risk of developing alopecia.
Sudden loss of hair is defined, usually small round patches in the beginning. Coin-sized patches of hair begin to fall.
The typical diagnosis procedure includes Hair analysis and Blood tests
Doctors might examine a few hair samples using a microscope
If other autoimmune conditions are suspected for hair, then doctors might suggest blood tests to be done
Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. The hair may fall out when they are stopped. These include:
Potent or ultrapotent topical steroids
Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, beard or eyebrow alopecia areata may speed up regrowth of hair. Its effect is temporary. If bald patches reappear, they can be reinjected.
Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. Most physicians agree that long-term systemic steroid treatment is not justified because of potential and actual adverse effects.
The sensitizing agent’s diphenylcyclopropenone (diphencyprone) and dinitrochlorobenzene provoke contact allergic dermatitis in treated areas. These sensitizers can be reapplied once weekly to bald areas on the scalp. The resultant dermatitis is irritating and may be unsightly. It is often accompanied by a swollen lymph gland.
There is no convincing data to support the use of methotrexate, sulfasalazine, azathioprine, ciclosporin or phototherapy.
Several patients with severe alopecia areata have had improvement when treated with oral tofacitinib or oral ruxolitinib, which are Janus kinase (JAK) inhibitors. It is thought they may act by blocking interleukin (IL)-15 signaling. Watch out for the results of clinical trials of these biologic medicines.