Alopecia Areata Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Alopecia Areata Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


What Is Alopecia Areata?


Alopecia areata is a condition that causes a person's hair to fall out. (Alopecia is the medical term for hair loss; there are various types of alopecia, including alopecia areata.)

Alopecia areata is an autoimmune disease, where a person's immune system attacks the body, in this case, the hair follicles. When this happens, the person's hair begins to fall out, often in clumps the size and shape of a quarter. The extent of the hair loss varies; in some cases, it is only in a few spots. In others, the hair loss can be greater. On rare occasions, the person loses all of the hair on his or her head (alopecia areata totalis) or entire body (alopecia areata universalis).

It is believed that the person's genetic makeup may trigger the autoimmune reaction of alopecia areata, along with a virus or a substance the person comes into contact with.

Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique. Even if someone loses all of his or her hair, there is a chance that it will grow back.

Currently there is no cure for alopecia areata, but there are some treatments that may help speed up the growth of hair afterward.

What causes alopecia areata?


It isn't fully known why some people develop alopecia areata. It’s an autoimmune disease, which means your body's immune system attacks your hair follicles. This reaction prevents new hair from forming and causes existing hair to fall out.

Current evidence suggests that alopecia areata is caused by an abnormality in the immune system. This particular abnormality leads to autoimmunity, a misguided immune system that tends to attack its own body. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, the body's own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune lymphocytes penetrating into the hair bulb of the hair follicles. Alopecia areata is occasionally associated with other autoimmune conditions such as allergic disorders, thyroid disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative colitis. The diagnosis or treatment of these diseases is unlikely to affect the course of alopecia areata. Sometimes, alopecia areata occurs within family members, suggesting a role of genes.

The condition is also more common in people who have Down’s syndrome. There is also some evidence that the condition can develop after a stressful event, such as bereavement.

If you have alopecia areata you also have a slightly higher than average chance of developing other autoimmune diseases such as thyroid disorders, pernicious anaemia and vitiligo. (However, it is important to stress that most people with alopecia areata do not develop any of these other conditions.)

Who gets alopecia areata?


Anyone can develop alopecia; however, your chances of having alopecia areata are slightly greater if you have a relative with the condition . In addition, alopecia areata occurs more often among people who have family members with autoimmune disorders such as diabetes, lupus, or thyroid disease.

What are the symptoms of alopecia areata?


The typical pattern is for one or more bald patches to appear on the scalp. These tend to be round in shape, and about the size of a large coin. They develop quite quickly. A relative, friend, or hairdresser may be the first person to notice the bald patch or patches. Apart from the bald patch or patches, the scalp usually looks healthy and there is no scarring. Occasionally, there is some mild redness, mild scaling, mild burning, or a slightly itchy feeling on the bald patches.

The first picture shows several patches of alopecia on the scalp in someone with fairly extensive alopecia areata. The second picture shows an area of alopecia of the beard area.

When a bald patch first develops, it is difficult to predict how it will progress. The following are the main ways it may progress:

  • Quite often the bald patch or patches re-grow hair within a few months. If hair grows back, it may not have its usual colour at first and look grey or white for a while. The usual colour eventually returns after several months.
  • Sometimes one or more bald patches develop a few weeks after the first one. Sometimes the first bald patch is re-growing hair whilst a new bald patch is developing. It can then appear as if small bald patches rotate around different areas of the scalp over time.
  • Sometimes several small bald patches develop and merge into a larger bald area.
  • Patches of body hair, beard, eyebrows, or eyelashes may be affected in some cases.
  • Large bald patches develop in some people. Some people lose all their scalp hair. This is called alopecia totalis.
  • In a small number of cases, all scalp hair, body hair, beard, eyebrows, and eyelashes are lost. This is called alopecia universalis.
  • The nails are affected in about 1 in 5 cases and can become pitted or ridged.
Some people become self-conscious, anxious or distressed by the appearance of the hair loss.

How is alopecia areata diagnosed?


Alopecia areata is diagnosed through a medical history and physical examination. Your doctor will ask you questions about your hair loss, look at the pattern of your hair loss, and examine your scalp. And he or she may tug gently on a few hairs or pull some out.

If the reason for your hair loss is not clear, your doctor may do tests to check for a disease that could be causing your hair loss. Tests include:

  • Hair analysis. Your doctor will take a sample of your hair and examine it under a microscope. A scalp sample is also sometimes taken.
  • Blood tests, including testing for a specific condition, such as an overactive or underactive thyroid gland (hyperthyroidism or hypothyroidism).

What are the treatment options for alopecia areata?


Self-help


If you have mild alopecia areata, you may decide not to have any treatment. Your GP may suggest that you wait for up to three months to see whether your hair grows back without treatment.

You can wear a hat or a bandana to cover up any patches of hair loss. Alternatively, you may wish to consider wearing a wig, which can be of human or synthetic hair. You can sometimes get a prescription from your GP for a wig – ask him or her for more advice about wigs.

Your hair usually provides some protection from the sun to the skin on your head. If you have alopecia areata, it’s important to take care to apply sunscreen to the areas of hair loss if you’re outside in sunny weather. Make sure you use a broad spectrum sunscreen – this means it protects your skin against both ultraviolet A (UVA) and UVB rays. It should have a sun protection factor (SPF) of at least 15. It's also a good idea to wear a hat when you’re outdoors.

Not treating is a common option


Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. In particular, if there are just one or two small bald patches then many doctors would advise that you simply leave it alone at first. This is sometimes called watchful waiting. 

If the hair loss is not too bad then there is a good chance that your hair will re-grow after several months. (Any re-growth usually does not start within three months of hair loss.) A change in hairstyle may perhaps conceal one or two small bald patches. If the hair loss becomes more extensive, then the decision on whether to treat can be reconsidered. But even with extensive hair loss, there is still a chance that hair will re-grow without treatment.

Note: alopecia areata itself won't damage your general health and so not treating will not lead to any general health problems. When considering any treatment choices, you should take into account the possible side-effects that some of the treatments may have. Also, treatments promote hair to re-grow and do not affect or cure the underlying cause of the condition.

Steroid injections


Injections of steroid into the bald patches of the scalp suppress the local immune reaction that occurs in alopecia areata. This can then allow the hair follicles to function normally again for hair to re-grow. This treatment may be an option for one or more small- to medium-sized bald patches. Steroid injections are thought to be the most effective treatment for patches of alopecia areata that are not too big. However, they do not work in every case.

This treatment is usually only done by a skin specialist and referral to hospital will usually be needed. Several injections (about 1 cm apart) are usually given at each session of treatment but the number is often limited by pain. Therefore, large bald areas are not suitable for steroid injections. Initial re-growth takes 1-2 months and injections are repeated every 4-6 weeks.

Note: there is no guarantee that any hair re-grown during treatment will persist once the treatment is finished.

Topical (rub-on) steroid


Steroid cream, gel, etc, may help hair re-growth, but does not work as well as steroid injections. It may be worth a try if you have bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist to have steroid injections. If re-growth occurs, it takes 3-6 months. There is no point continuing with this treatment if you do not develop any re-growth after six months.

Minoxidil solution


This is rubbed into the bald patches and has been shown to promote hair re-growth in some cases. This is the same treatment that is used for the common male pattern baldness. It is not known how it works. The success rate is not high but may be worth a try - in particular, if you have more extensive bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist for steroid injections.

Minoxidil is not available on the NHS. You need a private prescription and have to pay the full cost of the product, which makes it expensive. Also, some people with certain medical conditions may not be able to use it. So, before buying it, check with your doctor or pharmacist that it is suitable for you. If it works, it usually takes 2-3 months of treatment for an initial response, and one year for a maximum response. There is no point continuing with this treatment if there is no improvement after one year.

Topical immunotherapy


It is thought that topical immunotherapy is the most effective option for people with extensive alopecia areata. However, this treatment is only done by some skin specialists and so you will need to be referred to one of these specialists for it.

How topical immunotherapy works is not clear. A substance is put on affected skin to make the skin react like an allergy. A commonly used substance is diphencyprone (DPCP). Increasing strengths of this substance are placed on the affected skin once a week over several weeks until the skin looks like it has mild dermatitis (eczema). The skin reaction seems to affect the process involved in causing alopecia areata in some way to allow hair to re-grow. Side-effects can be troublesome. For example, some people develop severe skin reactions. Treating children with topical immunotherapy is controversial.

Once re-growth occurs, treatment can be stopped but, in many cases, the hair loss then recurs. Therefore, regular maintenance treatment is often needed to keep the hair loss from returning.

Wigs


Wigs are a common treatment choice in patients with alopecia areata. You can get some wigs on the NHS. However, this needs a referral to hospital as only a skin specialist can sanction the prescription of a wig on the NHS.

Other treatments for Alopecia Areata


Various other treatments may be used or advised. These include the following:

  • Psoralen combined with ultraviolet A (PUVA) light therapy or phototherapy has been used with some limited success. This treatment requires many light therapy sessions in a hospital outpatient department.
  • Dermatography (tattooing) can be used to simulate eyebrows that have fallen out.
  • Counselling is sometimes helpful for people who find it difficult to cope with hair loss.
  • Remembering to use sunblock or a hat to protect bald patches when out in the sun.
There is not enough evidence to say how effective complementary treatments are in treating alopecia areata (for example, acupuncture, aromatherapy, etc).

How Can Alopecia Areata Be Prevented?


There is no way to prevent alopecia areata. If you are concerned about developing this condition at some point, you can find out if your relatives have it so you have an idea of whether you are susceptible to this disease. If you find you have a better-than-average chance of developing it, all you can do is:
  • Research the disease.
  • Ask your doctor any questions you have.
  • Find out more about the treatment options.


Other Tips - Home remedies for Alopecia Areata


Apart from drug treatments, there are various cosmetic and protective techniques that people with alopecia areata can try. These include:

  • Using makeup to hide or minimize hair loss
  • Wearing coverings (wigs, hats, or scarves) to protect the head from the elements
  • Reducing stress. Many people with new-onset alopecia areata have had recent stresses in life, such as work, family, deaths, surgeries, accidents, etc. However, this has not been proven scientifically as a cause of alopecia areata.
While the disease is not medically serious, it can impact people psychologically. Support groups are available to help people with alopecia areata deal with the psychological effects of the condition. Further information may be found at the National Alopecia Areata Foundation.