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Going through hair loss and balding at any age is distressing. Alopecia Areata is one of the most common causes of hair loss globally. While not life-threatening, this frustrating autoimmune condition is responsible for significant loss of self-esteem and emotional well-being. This blog delves into the causes, symptoms, and latest treatment options of Alopecia Areata, offering guidance and support to the millions of people affected by it worldwide.
Who Gets Alopecia Areata?
Alopecia Areata is a form of autoimmune hair loss. It causes spot or disc-shaped areas of hair loss, particularly on the scalp. An autoimmune disease triggers the body’s immune response against its cells and tissues, leading to inflammation and damage.
Alopecia areata is a common cause of hair loss worldwide, trailing after male and female pattern baldness. Although it can affect anyone and at any age, hair fall from alopecia areata is most frequently seen in:
Children
Individuals with a positive family history of alopecia areata
Individuals with a family history of autoimmune disease (Hashimoto's thyroiditis, Lupus, etc.)
People with a genetic predisposition for alopecia areata
Stress, anxiety, or trauma (possible triggers)
There are several types of alopecia areata:
Alopecia Areata Totalis
As the name suggests, this type of hair loss from alopecia areata affects the scalp and leads to complete hair loss. The hair may grow back, but the possibility is less than in other forms of alopecia areata.
Patchy Alopecia Areata
The hair fall in this type of alopecia is patchy. The patches are usually small and round. It is highly likely for hair to regrow. However, new areas of hair loss may eventually appear.
Alopecia Areata Universalis
This is the most severe and least common type of alopecia areata. It leads to hair loss all over the body.
Diffuse Alopecia Areata
Diffuse alopecia presents with hair thinning rather than frank hair loss.
Ophiasis Alopecia Areata
There is a distinct pattern of hair fall in Ophiasis. The hair on the temples and a band of hair along the back of the head (occipital region) is lost.
How Common is Alopecia Areata?
Hair loss from alopecia areata is fairly common worldwide. It affects both genders equally as well as children. The prevalence of this autoimmune disease is only second to pattern baldness as a cause of hair loss globally. There is no specific age of onset for alopecia areata; however, most cases of hair loss due to it present before the age of 30.
Alopecia areata does not discriminate based on age, gender, ethnicity, or location. Its presentation may vary from person to person. The symptoms may come and go, adding to the anxiety and stress of those who suffer from this frustrating disease.
What Happens if You Have Alopecia Areata?
If you have alopecia areata, your immune system is mistakenly targeting your hair follicles. Depending on the type of alopecia areata, the pattern of hair loss may vary between total, diffuse, localized, or patchy.
Pathophysiology
There are three steps to the pathophysiology of alopecia areata:
Triggering of the Immune System
The immune system mistakenly identifies the hair follicles as “foreign”, triggering an inflammatory response.
Disruption of Hair Follicles
The immune cells surround the base of the follicles and release pro-inflammatory chemicals (cytokines), which disrupt the growth phase (Anagen) of the hair follicles.
Interruption of Growth
The hair follicles enter the resting or telogen phase suddenly and eventually fall off. The important point is that the follicle is not destroyed. Regrowth may be possible if the inflammatory reaction is treated or controlled.
Alopecia areata hair fall is not life-threatening. However, it has a significant impact on a person’s confidence, self-esteem, and social interactions, leading to stress and depression. The condition also varies between individuals, with some only getting one episode of hair loss, while others having recurrent flare-ups. The good news is that most forms respond well to alopecia areata treatment and regrowth is a definite possibility.
What are the Symptoms of Alopecia Areata?
The main symptom of alopecia areata is hair loss. The pattern of this hair loss may differ based on the specific type of alopecia areata. Hair fall of alopecia areata may target any hair-bearing part of the body, including the eyebrows, eyelashes, armpits, etc. People who have alopecia areata may have nail pitting, brittleness, and ridges as well.
Rarely, the patches of hair loss in alopecia areata may be associated with white hair growth, itching, follicular ostia, dot-like visible hair shafts, tingling or burning sensation, etc. Although regrowth is possible in mild cases of alopecia areata, the new hair follicles may be fine, completely white, or have patchy pigmentation.
What Causes Alopecia Areata?
Alopecia areata is an autoimmune disease. The exact cause for it is not known. However, some triggers may initiate an attack of alopecia areata. These include:
Emotional trauma (stress, anxiety, depression, PTSD)
Physical trauma
Illness and infections (Viral, bacterial)
Certain vaccines
Hormonal fluctuations (puberty, menstruation, pregnancy, menopause)
Toxins, allergens
Susceptible genetics
Scalp injury
How is Alopecia Areata Diagnosed?
There is no single investigation (blood test or scan) that can definitively make a diagnosis of alopecia areata. It is diagnosed by evaluating the patient based on a detailed history, physical examination, relevant tests, and lab analysis. After history and examination, the healthcare provider will do an in-depth examination of the sites of hair loss due to alopecia areata. This examination may include:
Looking for infections and allergies
Taking hair samples for lab evaluation
Scalp biopsy
Blood tests (Complete Blood Count)
Unfortunately, alopecia areata won’t resolve on its own and is not curable. Alopecia areata treatment manages the extent of hair loss, aims to decrease inflammation, and promotes regrowth. Alopecia totalis and universalis are less likely to improve and respond to treatment. The treatment options include Corticosteroids, Minoxidil, Phototherapy, platelet-rich plasma Therapy, and topical immunotherapy. Alopecia areata responds poorly to treatment in children, individuals suffering from other autoimmune disorders, and those who have experienced prolonged periods without hair regrowth.
