Alopecia areata is a common cause for hair loss and may be immune-mediated. The immune system doesn’t identify the hair follicles (roots) as own and consider them as foreign substances in affected people (autoimmunity). The process of alopecia areata and regrowth of hairs are poorly understood. It is linked with some other autoimmune diseases like vitiligo (white areas of the skin), diabetes mellitus, and thyroid disease. People with alopecia areata are more prone to have these disorders, although the risk of developing those diseases is low. The health-care professional may offer a blood test for antibodies, which may predict whether an affected individual is prone to develop pernicious anaemia or thyroid diseases.
Alopecia areata is not associated with vitamin deficiencies or diet. However, stress occasionally seems to be a triggering factor for alopecia areata. There are some genetic factors, which triggers the development of the condition. Therefore, family members of a person with alopecia areata can be affected.
Alopecia areata usually occurs in children or young adults and presents with smooth round patches of baldness. However, it can appear at any age. The patches are not scaly or inflamed. Sometimes, alopecia areata can be diffuse instead of round patches. Old patches may regrow while new patches of hair loss appear. At the edge of a bald area, there are broken exclamation mark hairs. They are narrow at the scalp skin and more pigmented and wider at the tip (short tapered hairs). This is a diagnostic feature of alopecia areata. This condition seems to damage the pigmented hair compared to the white hairs. Therefore, some amount of white hairs can be left within the bald patches in the elderly. Sometimes, a tingling sensation in the affected areas may occur. Hair regrowth may initially occur with fine white hairs at the centre of the patch. New hairs regain their colour and thicken eventually. However, this is a slow process and usually occurs over months or years.
Hairs in other places like eyebrows, eyelashes, beard, limbs, and body can be involved. Sometimes, all the scalp hair can be lost (alopecia totalis). Rarely, all body hair may be lost (alopecia universalis). In alopecia universalis and alopecia totalis, the probability of total recovery is much less. The nails may be roughened or pitted. Severity or regrowth of alopecia areata cannot be predicted.
Alopecia areata is not curable. If the affected areas are patchy rather than diffuse, about 60-80 % patients will have complete regrowth in one year without any treatment. Sometimes, recurrences of alopecia areata can occur in the future. If there is severe hair loss from the beginning, the likelihood of regrowth may be poor. If the affected individual has Down’s syndrome or severe eczema, the probability of regrowth will be poor.
Usually, treatment has no significant effect on the long-term progression of alopecia areata. Powerful injected or topical steroids may have limited benefits. Topical 5 % minoxidil, photochemotherapy called PUVA (Psoralen combined with ultraviolet A), or immunotherapy with diphencyprone is occasionally used but usually does not resolve the problem. For severe hair loss, wigs are offered. Patient support groups are usually helpful.
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