Alopecia Areata is a hair loss disease that occurs due to the immune system attacking hair follicles. While hair can be lost from any part of the body, Alopecia Areata usually affects the head and face. The hair loss occurs in small, round patches about the size of a quarter, but in some cases, hair loss is more extensive.
The progression of Alopecia Areata can differ among individuals. Some may experience intermittent episodes of hair loss repeatedly, while others may have a single occurrence. The likelihood of complete hair restoration after hair loss is also uncertain, as it may occur in some individuals but not in others.
The disease affects roughly 6.8 million people in the United States and 147 million people worldwide. There is no cure for Alopecia Areata, but there are treatments that help hair grow back more quickly, and resources to help people cope with hair loss.
Who Gets Alopecia Areata?
Alopecia Areata can affect anyone regardless of gender, race, or ethnicity. Its onset can occur at any age, but it is more commonly observed in individuals during their teens, twenties, or thirties. In children younger than 10 years old, the disease tends to be more extensive and progressive.
While some individuals may have a higher risk of developing Alopecia Areata if a close family member has the disease, many people have no family history of the disease. Studies have linked several genes related to the immune system with the disease, indicating that genetics play a role in Alopecia Areata.
People with autoimmune diseases such as psoriasis, thyroid disease, or vitiligo, and those with allergic conditions like hay fever, have a higher likelihood of getting Alopecia Areata. Emotional stress or an illness may trigger the disease in people who are at risk, but in most cases, there is no obvious trigger.
It is important to note that children and adults with Alopecia Areata are at risk of developing other autoimmune diseases such as thyroid disease, atopic dermatitis, or other autoimmune diseases, making it important to regularly visit a primary care doctor for early diagnosis and management.
Types of Alopecia Areata
There are three main types of Alopecia Areata; Patchy, Alopecia Totalis, and Alopecia Universalis.
Patchy Alopecia Areata is the most common type, hair loss happens in one or more coin-sized patches on the scalp or other parts of the body.
Alopecia Totalis is when people lose all or nearly all of the hair on their scalp.
Alopecia Universalis is the rarest type, where there is a complete or nearly complete loss of hair on the scalp, face, and rest of the body.
Symptoms of Alopecia Areata
Alopecia Areata disease is not life-threatening, it can cause significant emotional distress to the affected individuals. The symptoms of Alopecia Areata include hair changes and nail changes.
The most prominent symptom of Alopecia Areata is sudden loss of round or oval patches of hair on the scalp, beard area in men, or the eyebrows and eyelashes. The bare patches usually do not show any sign of rash, redness, or scarring. Around the edges of the patch, there are often short broken hairs or “exclamation point” hairs that are narrower at their base than their tip. Hair loss can occur suddenly, developing in just a few days or over a period of a few weeks. There may be itching or burning in the affected area before hair loss.
The hair follicles in Alopecia Areata are not destroyed, and hair can regrow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment. However, about 30 percent of individuals who develop Alopecia Areata find that their condition either becomes more extensive or becomes a continuous cycle of hair loss and regrowth. About half of the patients recover from Alopecia Areata within one year, but many will experience more than one episode. Around 10 percent of people will go on to develop alopecia totalis or alopecia universalis.
Alopecia Areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are a number of small changes that can occur to nails, including pinpoint dents, white spots and lines, roughness, loss of shine, thinning, and splitting. The presence of these nail changes can be an early indicator of Alopecia Areata.
Additional Clinical Signs
Other clinical signs of Alopecia Areata include “exclamation mark” hairs, where a few short hairs grow in or around the edges of bald spots, and “cadaver” hairs, where hairs break before reaching the skin surface. Additionally, white hair may grow in areas affected by hair loss.
Research Data on Race and Ethnicity
According to a 2019 study based on an analysis of over 11,000 cases in the National Alopecia Areata Registry between 2000 and 2016, the odds ratios of an Alopecia Areata diagnosis for People of Color when compared to white people were higher for African American people (1.77), other races including Native Americans and Pacific Islanders (1.27), and Hispanic people (.9) while lower for Asian people (.4).
Similarly, a 2018 cross-sectional analysis from the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII) found higher odds for a diagnosis of Alopecia Areata in Black women (2.72 per the NHS and 5.48 per the NHSII) and Hispanic women (1.94) compared to white women.
However, more studies are needed to explore the patterns and determinants of Alopecia Areata in different ethnic groups, including environmental, behavioral, genetic, and socioeconomic factors, as well as access to healthcare.
Causes of Alopecia Areata
It is believed that a 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. Scientists have linked a number of genes to the disease, which suggests that genetics play a role in Alopecia Areata. Many of the genes they have found are important for the functioning of the immune system.
People with certain autoimmune diseases, such as psoriasis, thyroid disease, or vitiligo, are more likely to get Alopecia Areata, as are those with allergic conditions such as hay fever. It is possible that emotional stress or an illness can bring on Alopecia Areata in people who are at risk, but in most cases, there is no obvious trigger.
Diagnosis of Alopecia Areata
Alopecia Areata primarily affects hair, but in some cases, there are nail changes as well. The most prominent symptom of Alopecia Areata is sudden loss of round or oval patches of hair on the scalp, but any part of the body may be affected, such as the beard area in men, or the eyebrows or eyelashes. Around the edges of the patch, there are often short broken hairs or “exclamation point” hairs that are narrower at their base than their tip.
There is usually no sign of a rash, redness, or scarring on the bare patches. Nail changes can occur before hair loss, which is characterized by pinpoints dents, white spots and lines, rough, thin, split nails, and nails losing their shine. The diagnosis of Alopecia Areata is based on clinical findings and medical history. Biopsy is rarely necessary.
Treatment for Alopecia Areata
While a cure for Alopecia Areata is not currently available, the condition can be managed with treatment and hair regrowth is possible. In some cases, hair can grow back without any treatment, especially for people with milder cases.
Corticosteroids are the most common drugs prescribed to treat Alopecia Areata. These anti-inflammatory drugs are typically used for autoimmune diseases and can be given as injections into the scalp or other areas, orally as a pill, or applied topically as an ointment, cream, or foam. Response to therapy may be gradual. Other medications that can be prescribed to promote hair growth or affect the immune system include Anthralin, SADBE, and DPCP. While these medications may help with the regrowth of hair, they cannot prevent the formation of new bald patches.
Minoxidil, also known as Rogaine®, is a topical drug that is already used as a treatment for pattern baldness. It typically takes about 12 weeks of treatment with Rogaine for hair to begin to grow.
In some cases, photochemotherapy may also be recommended as a potential alternative for patients who are unable or unwilling to use systemic or invasive therapies.
Alopecia Areata is a condition for which conventional treatments are limited, and natural remedies are not well studied. Although some people recommend using onion or garlic juice, cooled green tea, almond oil, rosemary oil, honey, or coconut milk topically on the scalp, there is limited scientific evidence to support their effectiveness.
Additionally, alternative therapies such as acupuncture and aromatherapy lack sufficient scientific evidence to support their use as treatments for Alopecia Areata. Therefore, it is recommended to seek medical advice and treatment from a healthcare provider before attempting any home remedies or alternative therapies for this condition.
Who Treats Alopecia Areata?
Alopecia Areata is a condition that is commonly treated by dermatologists who specialize in the diagnosis and treatment of skin, hair, and nail disorders. These specialists have the expertise and knowledge to provide patients with the best possible care for their condition.
In addition to dermatologists, other healthcare professionals may be involved in the care of patients with Alopecia Areata. Mental health professionals can help patients cope with the emotional and psychological challenges associated with having a medical condition. They can provide support, counseling, and other therapies to help patients manage their anxiety, depression, and other mental health issues.
Primary care doctors, including family physicians and internal medicine specialists, can also play a role in the treatment of Alopecia Areata. These doctors can help coordinate care between different healthcare providers and treat any other medical conditions that patients may have.
Living With Alopecia Areata
Besides drug treatments, several cosmetic and protective techniques may help individuals with alopecia manage their condition. These techniques include:
Protecting bare skin and staying comfortable
- Using sunscreens to protect any bare areas from harmful ultraviolet radiation
- Using makeup to hide or minimize hair loss
- Wearing wigs, hairpieces, hats, or scarves to protect the scalp from the sun and keep the head warm
- Wearing eyeglasses or sunglasses to protect the eyes from the sun and dust if hair loss has affected the eyebrows or eyelashes
- Eating a well-balanced diet rich in vitamins and minerals, which are necessary for healthy hair growth. Avoiding fad diets that may lead to hair loss, although not specifically related to Alopecia Areata
- Reducing stress, as some people with new-onset Alopecia Areata may have recently experienced stressful events such as work, family, deaths, surgeries, or accidents.
Considering Cosmetic Solutions
- Wearing a wig, hairpiece, or bandana to cover up hair loss. Alternatively, some people may choose to shave their heads to mask patchy hair loss
- Using fake eyelashes or stick-on eyebrows if hair loss has affected the eyelashes or eyebrows. Makeup or tattoos can also help disguise the loss of eyebrow hair.
Individuals with Alopecia Areata are at a greater risk of developing certain health conditions, including thyroid disease, atopic dermatitis, and other autoimmune disorders. Therefore, it is imperative for those with Alopecia Areata to regularly visit their primary care physician to monitor their health status. Early detection of any potential health complications can aid in prompt management and prevent disease progression. Hence, individuals with Alopecia Areata should prioritize regular medical check-ups to ensure their overall health and wellbeing