Q. Why did I develop this problem? What is Alopecia Areata?
A. Alopecia areata is an autoimmune disease. In alopecia areata, this means that immune system cells called white blood cells attack hair follicles. Hair fibers are shed and the hair follicle/hair fiber growth process is slowed down. Genetic factors may be important in disease susceptibility and severity but overall, scientists do not know exactly why the immune system attacks hair follicles in some people. In those who are genetically predisposed, it is possible some type of trigger, such as something in the person’s environment or a virus, triggers the attack on the hair follicle.
In most cases, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the head (referred to as alopecia areata totalis) or complete loss of hair on the head, face, and body (alopecia areata universalis).
Q. What Causes It?
A. In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles that make the hair. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.
Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger – perhaps a virus or something in the person’s environment – brings on the attack against the hair follicles.
Q. Do I need to have blood or other tests done to determine if my hair loss is a symptom of some more serious?
A. Alopecia areata may occur more commonly in people who have other autoimmune diseases such as thyroiditis, Addison’s disease, and pernicious anemia (Vitamin B-12 deficiency). Therefore, it is important that your doctor take a careful medical history and obtain any necessary blood tests based on your medical history and physical examination.
The hair loss resulting from Alopecia areata is not life-threatening by itself . It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.
The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.
Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.
Q. Can I pass it on to my Children?
A. It is possible, but not likely, for alopecia areata to be inherited. Most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which a child has a 50–50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55-percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.
Q. Will my hair grow back?
There is every chance that your hair will regrow, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on their head; some lose all the hair on their head, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.
In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.
Q. I’ve been told no treatment effects the natural course of this disorder. Is that true?
A. There is currently no “cure” for alopecia areata and in there are no specific drugs which are approved specifically for the treatment of this disease. Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes, such as those commonly prescribed to promote hair growth or to reduce the body’s inflammatory response , can help hair grow back, at least temporarily. The following are some treatments for alopecia areata. Keep in mind that although these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Some of these are:
Corticosteroids – Corticosteroids are powerful anti-inflammatory drugs similar to a hormone called cortisol, which is produced in the body. Because these drugs suppress the immune system if given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be administered in three ways for alopecia areata:
Local injections – Injections of steroids directly into hairless patches on the scalp and sometimes the brow and beard areas are effective in increasing hair growth in most people. It usually takes about 4 weeks for new hair growth to become visible. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped. Because injections can be painful, they may not be the preferred treatment for children. After 1 or 2 months, new hair growth usually becomes visible, and the injections usually have to be repeated monthly. The cortisone removes the confused immune cells and allows the hair to grow. Large areas cannot be treated, however, because the discomfort and the amount of medicine become too great and can result in side effects similar to those of the oral regimen.
Oral corticosteroids – Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in more extensive alopecia areata. But because of the risk of side effects of oral corticosteroids, such as hypertension and cataracts, they are used only occasionally for alopecia areata and for shorter periods of time.
Topical ointments – Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections; they work best when combined with other topical treatments, such as minoxidil or anthralin.
Minoxidil (5 percent) – Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. It is primarily used to treat male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. If Minoxidil is effective,, with regular and proper use of the solution, new hair growth appears in about 12 weeks.
Anthralin – Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes (“short contact therapy”) to avoid skin irritation, which is not needed for the drug to work. When it works, new hair growth is usually evident in 8 to 12 weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.
Sulfasalazine – A sulfa drug, sulfasalazine has been used as a treatment for different autoimmune disorders, including psoriasis. It acts on the immune system and has been used to some effect in patients with severe alopecia areata.
Topical sensitizers – Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in 3 to 12 months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.
Oral cyclosporine – Originally developed to keep people’s immune systems from rejecting transplanted organs, oral cyclosporine is sometimes used to suppress the immune system response in psoriasis and other immune-mediated skin conditions. But suppressing the immune system can also cause problems, including an increased risk of serious infection and possibly skin cancer. Although oral cyclosporine may regrow hair in alopecia areata, it does not turn the disease off. Most doctors feel the dangers of the drug outweigh its benefits for alopecia areata.
Photochemotherapy – In photochemotherapy, a treatment used most commonly for psoriasis, a person is given a light-sensitive drug called a psoralen either orally or topically and then exposed to an ultraviolet light source. This combined treatment is called PUVA. In clinical trials, approximately 55 percent of people achieve cosmetically acceptable hair growth using photochemotherapy. However, the relapse rate is high, and patients must go to a treatment center where the equipment is available at least two to three times per week. Furthermore, the treatment carries the risk of developing skin cancer.
Alternative therapies – Alternative therapies purported to help alopecia areata include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, Chinese herbs and dietary regimens. Because many alternative therapies are not backed by clinical trials, they may or may not be effective for regrowing hair. In fact, some may actually make hair loss worse. Furthermore, just because these therapies are natural does not mean that they are safe.
Q. My child has alopecia totalis or universalis. Is he or she likely to regrow his hair?
A. This is a difficult question to answer as the course of the disease varies from person to person. Your child may regrow his hair spontaneously and never have another episode of hair loss again or he may regrow his hair only to lose it again later with a recurrent episode of alopecia areata. Some people with alopecia areata may never grow back their lost hair. Medical treatment of his alopecia totalis may help him regrow his hair but again one cannot guarantee the alopecia areata will not recur. From published research studies, it appears the outlook or prognosis for hair regrowth will be positive if the disease has been present for less than two years and your child does not have atopy. Atopy is the term used to describe three major diseases including asthma, allergic rhinitis (hay fever) and atopic dermatitis (eczema). Some, but not all, researchers have reported a worse prognosis if severe nail changes are also present. The nail changes which have been described include thinning of the nail plate and severe pitting and ridging.
Q. How will Alopecia Areata affect my life? How can i cope with the emotional effect of this disease?
A. This is a common question, particularly for children, teens, and young adults who are beginning to form lifelong goals and who may live with the effects of alopecia areata for many years. The comforting news is that alopecia areata is not a painful disease and does not make people feel sick physically. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy and it should not interfere with the ability to achieve such life goals as going to school, working, marrying, raising a family, playing sports, and exercising.
The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease; speaking with others who are facing the same problem; and, if necessary, seeking counseling to help build a positive self-image.
Living with hair loss can be hard, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.
The key to coping is valuing yourself for who you are, not for how much hair you have or don’t have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. Nearly 2 percent of Americans have this disease at some point in their lives, so you are not alone.
Another way to cope with the disease is to minimize its effects on your appearance. If you have total hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.
Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child’s interest and mood – some even have ponytails attached.
For women, attractive scarves can hide patchy hair loss; jewelry and clothing can distract attention from patchy hair; and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of alopecia areata, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.
Q. Is research close to finding better treatments or a cure?
A. Despite its prevalence, Alopecia Areata has been largely overlooked by the research community. For instance, in the United States Alopecia Areata affects roughly 5 million people; however, this disease only received a total of 5 grants in research funding from the US National Institute of Health in 2010. That is only 1 research grant per million of people affected. Conversely, research funding going into a very rare and highly treatable disease like Lyme Disease, which affects less than 0.0001% of the US population (30,000 people per year), amounted to 150 grants. That is 1 research grant per 200 people afflicted by Lyme Disease.
The most likely reason that research has been so grossly neglected is likely due to the perception that Alopecia Areata is primarily a cosmetic condition rather than a serious auto-immune disease that has far-reaching effects on those afflicted.
While some of the areas of research that have been identified as holding promise, the limited nature of research is the biggest obstacle to progress:
Developing an animal model – Researchers have identified an inbred strain of mice that spontaneously develops a condition similar to the adult-onset form of alopecia areata. This mouse model has already allowed researchers to identify some genetic factors that are involved in development of the disease. By studying mice with a disease similar to human alopecia areata, researchers hope to learn more about the mechanism of the disease.
Mapping genes – Scientists are studying the possible genetic causes and mechanism of the disease both in families that have one or more people with the disease and in the general population. An understanding of the genetics of the disorder could aid in disease prevention, early intervention, and development of specific therapies.
Studying hair follicle development – By studying how hair follicles form in mouse embryos, researchers hope to gain a better understanding of hair cycle biology that may offer insight into the underlying disease process.
Understanding stem cell biology – Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, scientists hope to gain a better understanding of factors that trigger the disease.
While each of these areas hold promise, much more research is necessary to make progress in understanding Alopecia Areata and developing effective treatments and a cure.
Q. How can I help?
A. There are several ways that you can help. If you are interested in supporting research for Alopecia Areata you can partner with Global Alopecia Mission by making a donation. Global Alopecia Mission, a non profit organization, is dedicated exclusively to comprehensive research leading to effective treatment and a cure for Alopecia Areata. There is no other organization set up for that purpose. You can make a donation by clicking on this DONATION link.
There are other ways to help in addition to partnering though a financial contribution. You can also:
Volunteer – There are many opportunities and areas of service where you can help in the fight against Alopecia Areata by giving some of your time to our cause.
Information – Knowledge is power in the fight against Alopecia Areata. You can help us increase our understanding by sharing your own experience with Alopecia Areata through completing our online Alopecia Areata Survey. Information from this confidential survey will be analyzed to look for large scale patterns and trends that may help identify triggering events, disease progression, and accurate growth and relapse rate, etc.
Emotional Supprt – Alopecia Areata is a tough disease to cope with emotionally for most people. If you would like to provide emotional support for those with AA or need support yourself, click on this support link for a list of groups whose primary function is to provide emotional support services.