Alopecia Areata
General Information
Alopecia Areata can be very devastating psychologically to people that suffer from it, perhaps even more devastating than Androgenetic Alopecia, the more common form of hair loss.
Alopecia Areata (AA) is an auto-immune disease. Auto-immune diseases are the result of the body's own natural defense system, the immune system going awry and attacking the body's own tissues. There are many forms of auto-immunity -- Multiple Sclerosis, Rheumatoid Arthritis, Vitiligo and Chron's Disease are all different forms of auto-immunity (and there are many others). Alopeica Areata occurs when the immune system attacks hair follicles.
This hair loss disease is characterized by the following:
it's unpredictable nature -- it can come and go in remitting and relapsing episodes of differing severities
it's occurrence in different parts of the body -- AA can occur in different areas of the scalp and other parts of the body.
it's severity variance -- the disease usually starts as one or more small patches of baldess on the scalp, but it can lead to total scalp loss (this is called alopecia totalis) and even total body hair loss (called alopecia universalis, see the following interview with Dr. Olavo Feher for an interesting perspective on this condition).
it often begins in childhood, but can start at any stage of life.
it is usually not life-threatening
There usually is no pattern to the loss of hair as in MPB (male pattern baldess) or FPB (female pattern baldness)
in some people only a few patches develop (usually round and smooth) which regrow within a year's time, whereas in others there can be quite a few large patches of loss (or even total loss) of hair.
the hair follicles are thought to still be alive and capable of producing normal hair if the correct signals are provided.
regrowth of lost hair can occur spontaneously, even without treatment, and after many years of no growth.
Causes of Alopecia Areata (AA)
Current research points towards immune system suppression of the hair follicle. While inroads are being made through research, the specific mechanisms behind why the immune system starts attacking the hair follicle in AA are not known. Perhaps a virus initially triggers it or perhaps some internal condition in the body triggers it, or maybe it is a combination of different internal and external factors.
Recent research suggests that genetics may be involved in causing susceptibility to alopecia areata and also in the degree to which one is susceptible -- heredity seems to be involved as one in five people that have it are related to someone else who has it. The later in life one develops AA the less likely it is that one is related to someone else who has it.
According to the National Alopecia Areata Foundation, AA occurs in families with individuals that have asthma, hay fever, eczema, thyroid disease, early-onset diabetes, rheumatoid arthritis, lupus, vitiligo, pernicious anemia, or Addison's disease.
Alopecia Areata does not seem to be related to the nervous system.
Treatments for Alopecia Areata
There are several effective treatments (of varying degree) available. Since alopecia areata has two forms -- a patchy forum where less than half of the scalp is effected, and an extensive form where more than half of the hair is lost -- the treatment modalities chosen are dependent on the form of AA present. Current treatments don't cure the disease completely, but they can stimulate hair follicle dermal papillae to generate hair again if used on a continual basis. The less severe the level of AA, the more effective the treatments are.
If the level of AA is the mild to moderate patchy form cortisone injections into the bare areas of skin and in surrounding areas can help. These injections are repeated monthly. Usually new hair will occur within 4 weeks if this method of treatment works. This treatment modality does not prevent new patches of AA from forming. Side-effects are limited but sometimes depressions can occur in the skin from local injections. If this happens the depressions usually fill in by themselves. Topical Minoxidil applied twice a day to effected areas can help. Anthralin cream (see the following abstract) has been shown to be effective. This is a tar-like substance used to treat psoriasis as well as AA. For AA it is applied to bare patches of skin once a day and washed off afterwards. New hair will grow withing two to three months if the treatment works for an individual. Anthralin can cause skin discoloration (which usually goes away) and irritation.
If the level of AA is severe (more than 50% of hair lost), then cortisone pills can be prescribed. When taken internally cortisone will have a systemic effect that is much stronger than when it is applied to skin locally. Prolongued use can cause health risks of its own. Unfortunately hair that is regrown will usually fall out if the pills are stopped. Topical Minoxidil can also be effective for this more severe form of AA, as well as topical immunotherapy.
Topical immunotherapy refers to when an allergic reaction is intentionally produced so that an allergic rash or contact dermatitis is caused. About 40% of patients on this form of treatment will regrow hair after about 6 months of treatment. Treatment must be continued to maintain regrowth until the disease turns itself off, as in the case of a prolongued remission.
The NAAF has announced that it has been awarded a $200,000 grant for a clinical trial to see if a new drug called Amevive (Alefacept) is useful in treating AA. Let's hope this bears fruit.
Here is a link to an amazing picture of an individual who was treated with diphenylcyclopropenone (DPCP): picture.
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