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Alopecia Areata

Key Takeaways

Alopecia Areata is a disorder where the body’s immune system mistakenly attacks the hair follicles leading to hair loss.

What causes this disorder is still not fully understood, however it is believed to be genetic in nature.

Many suffers tend to have a family history of Alopecia Areata and other autoimmune disorders.

While it can occur at any age, it often starts before the age of 30 in both sexes.

Alopecia Areata is often distinguished for its coin sized patches of hair loss on the scalp and other areas (beard and eyelashes).

it can also effect other parts of the body leading to complete body hair loss in less common cases.

Alopecia Areata can present in other forms as well, sometimes being mistaken for other types of hair loss.

The hair follicle is often not destroyed which means if the inflammation subsides, the hair can grow back.

Alopecia Areata is a disorder where the body’s immune system mistakenly attacks the hair follicles leading to hair loss.

Alopecia Areata

Alopecia Areata is an autoimmune disorder where the body’s immune cells mistakenly recognize the hair follicles as a threat and attack it, leading to hair loss. While the specific cause of Alopecia Areata is still debated, it is believed to have a genetic factor since many suffers tend to have a family history of Alopecia Areata and other autoimmune disorders.  

Stress is often mistakenly believed to play a role in the initiation of Alopecia Areata, however there is no scientific evidence for that.

 

Hair Loss Presentation

While Alopecia Areata can occur at any age, it often starts before the age of 30 in both sexes.

Alopecia Areata is often distinguished for its coin sized patches of hair loss on the scalp and other areas (beard and eyelashes). In some cases, this may be accompanied by irritation in the effected region.  White hairs may also grow in the affected regions. Alopecia Areata can also affect the nails and that can be the first signs of the disease. In this case, the patients nails can become dented, have white spots or lines, become thin and split or lose their shine.

However, Alopecia Areata can present in other forms as well and sometimes is mistaken for other types of hair loss. 

 

Here are different ways Alopecia Areata presents itself:

 

Alopecia Areata Focalis (Patchy

Alopecia Areata )

This is the most common form of Alopecia Areata where it causes several patches of hair loss on the scalp.  

 

Alopecia Areata Totalis

Some of the Alopecia Areata Focalis patients go on to develop hair loss on the entire scalp. This condition is then called Alopecia Areata Totalis.

 

Alopecia Areata Universalis

In some cases of Alopecia Areata Focalis, the hair loss extends to the entire body (including eyebrows, eyelashes, armpits etc.), this condition is then known as Alopecia Areata Universalis.

Alopecia Areata is a disorder where the body’s immune system mistakenly attacks the hair follicles leading to hair loss.

Alopecia Areata Marginata (Ophiasis)

This form of Alopecia Areata often effects the scalp sides (behind the ears, neck and sometimes hairline as well) and can also extend to the entire scalp.

 

Ophiasis Inversus

This form of Alopecia Areata presents on top of the scalp which then extends to the rest of the sclap. It is in an inverse pattern to the Ophiasis.

 

Alopecia Areata Incognita

This is a unique form of Alopecia Areata where instead of a patchy hair loss, the patient experiences a diffuse form of hair loss throughout the scalp. Correct diagnosis of this type of Alopecia Areata is essential as it can be mistaken for other types of hair loss.

 

A unique symptom of Alopecia Areata is known as the exclamation mark hair ( ! ) . The hairs effected by Alopecia Areata look thick along the shaft, however they appear thinner near the bulb giving them the shape of an exclamation mark ! .

Treatments   

The hair follicle is often not destroyed which means if the inflammation subsides, the hair can grow back. In fact many patients who suffer from a few patches of hair loss, can have a full recovery without intervention.

However, about a third of patients will experience an extensive hair loss or a continuous cycle of hair loss and recovery. While about half of the patients will eventually recover (usually after suffering several episodes), up to 10% go on to develop Alopecia Totalis or Alopecia Universalis.

Unfortunately, there is no definite cure for Alopecia Areata. Often corticosteroids which are powerful anti-inflammatory drugs are used to help with the regrowth. Other medications such as Minoxidil , Anthralin, Methotrexate , SADBE and DPCP can be used to help with the regrowth and suppression of immune system. In some cases other treatments such as Platelet Rich Plasma Therapy (PRP) and immunotherapy have been shown to improve the condition.

REFERENCES
  • Brzezińska-Wcisło L, Lis-Święty A. Hair diseases – what’s new? In: Szepietowski J, Reich A, editors. Dermatology – what’s new? [Polish] Wrocław: Cornetis; 2009. pp. 187–200.
  • Burgdorf WHC, Plewig G, Wolff HH, Landthaler M. Braun-Falco Dermatology [Polish] Lublin: Czelej; 2010. Hair diseases; pp. 1053–83.
  • Brzezińska-Wcisło L, Lis A, Kamińska G, Wcisło-Dziadecka D. Physiology and pathology of hair growth and loss on the human scalp [Polish] Postep Derm Alergol. 2003;20:260–6.
  • Brzezińska-Wcisło L, Wcisło-Dziadecka D, Meszyńska E, et al. New perspectives on the pathogenesis and treatment of hair disorders. Post Nauk Med. 2012;10:800–5.
  • MacDonald Hull SP, Wood ML, Hutchinson PE, et al. British Association of Dermatologists. Guidelines for the management of alopecia areata. Br J Dermatol. 2003;149:692–9.
  • Olsen EA, Carson SC, Turney EA. Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata. Arch Dermatol. 1992;128:1467–1473.
  • Garg S, Manchanda S. Platelet-rich plasma-an ‘Elixir’ for treatment of alopecia: personal experience on 117 patients with review of literature. Stem Cell Investig. 2017;4:64.

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