Alopecia areata

Alopecia areata

What is alopecia areata?

Alopecia is a general term for hair loss. Alopecia areata is a common cause of non-scarring (does not cause scarring to the scalp) hair loss that can occur at any age. It usually causes small, coin-sized, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes, body and limbs can be affected. In some people larger areas are affected and occasionally it can involve the whole scalp (alopecia totalis) or even the entire body and scalp (alopecia universalis).

It is not possible to predict how much hair will be lost. Regrowth of hair in typical alopecia areata is usual over a period of months or sometimes years, but cannot be guaranteed. The chances of the hair regrowing are better if less hair is lost at the beginning. Most people, with only a few small patches get full regrowth within a year. If more than half the hair is lost then the chances of a full recovery are not good. The hair sometimes regrows white, at least in the first instance. Most people get further attacks of alopecia areata. In alopecia totalis and alopecia universalis, the likelihood of total regrowth is less.

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What does it look like?

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Main body location

Face, Head, Scalp

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Can it appear anywhere?

Yes

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What causes alopecia areata?

Hair is lost because it is affected by inflammation. The cause of this inflammation is unknown but it is thought that the immune system, the natural defence which normally protects the body from infections and other diseases, may attack the growing hair. Why this might happen is not fully understood, nor is it known why only localised areas are affected and why the hair usually regrows again.

Someone with alopecia areata is slightly more likely than a person without it to develop other autoimmune conditions such as thyroid disease, diabetes, lupus and vitiligo (white patches on the skin), although the risk of getting these disorders is still very low. If you have other symptoms then discuss these with your doctor. Your doctor may suggest a blood test.

Alopecia areata is not catching and no connection has been made with food or vitamin deficiencies. Stress occasionally appears to be a trigger for alopecia areata, but it is possible that this link may be coincidental as many of those affected have no significant stress.

Is alopecia areata hereditary?

There is a genetic predisposition to alopecia areata. About 20% of people with alopecia areata have a family history.

What are the symptoms?

There may be a tingling sensation in the scalp. It can be a very upsetting condition, especially if the bald area cannot be disguised by hairstyle.

If alopecia areata affects the eyelashes, then the eyes may become sore due to dust, particularly in dry and windy conditions.

What does alopecia areata look like?

Typically, it starts as one or more bald, smooth patches on the scalp, which are not inflamed or scaly. It tends to affect the pigmented hair so there may be some white hairs left within the bald area in older people. Sometimes the hair loss is diffused rather than well-circumscribed patches. Short, tapered hairs, known as exclamation mark hairs that are characteristic of alopecia areata, may be seen at the edge of the bald patch. Regrowth usually starts at the centre of the bald patch with fine white hair that thickens with time and usually regains its colour. Some people with alopecia areata develop small pits on their nails, similar to the dimples seen on a thimble.

 

Animation by Stacy Bias, based on real-life interviews conducted by Goldsmiths anthropologist, Emma Tarlo. For further understanding of the social dimensions of hair, see her book, Entanglement: The Secret Lives of Hair. 

Can it be cured?

No, alopecia areata cannot be cured. Depending on the extent of hair loss there is a good chance that, for 4 out of 5 affected people, complete regrowth will occur within 1 year without treatment. There may, however, be further episodes of hair loss in the future. If there is very extensive hair loss from the start, the chances of it regrowing are not as good. Those with more than half the hair lost at the beginning or with complete hair loss at any stage have only about a 1 in 10 chance of full recovery. The chances of regrowth are not so good in young children and those with the condition affecting the hairline at the front, side or back.

How can alopecia areata be treated?

People with mild early alopecia areata may need no treatment, as their hair is likely to come back anyway without it. Some treatments can induce hair growth, though none is able to alter the overall course of the disease. Any treatments that carry serious risks should be avoided, as alopecia areata itself has no adverse effect on physical health.

What if I need a wig?

Some individuals with alopecia areata will prefer to wear a wig while they wait for recovery. These can either be bought privately, or obtained through the NHS on a consultant’s prescription (a financial contribution is usually required in England). Your local hospital orthotic (surgical appliances) department will be able to advise you on the range of hairpieces available on the NHS and can recommend local suppliers who are sensitive to the needs of individuals with alopecia areata.

What can I do?

  • You may find that joining a patient support group (see below) and meeting other people with alopecia areata will make it easier for you to adjust to your condition.
  • Some men and a few women with extensive alopecia find that shaving off the remainder of the hair provides a good solution.
  • Remember that an important function of hair is to protect the scalp from sunlight. You should cover your bald patches with a sun block or a hat to prevent sunburn and also to reduce the chances of developing long-term sun damage.
  • The hair also acts as an early warning to prevent scraping the scalp on low doors, cupboards or trees. Be particularly careful to avoid hurting yourself in these situations.
  • If you find that the regrowing hair is slow to recolour, it can be dyed after discussing with a good hairdressing salon.
  • A few people with longer hair find hair extensions help camouflage the problem. Some hairdressers become expert at this. It is important to avoid too much tension on any hair when this is done because this could cause hair loss, called traction alopecia.
  • Artificial eyelashes, eyebrow pencils and eyebrow tattoos can help some people with problems in these areas.

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This information is provided by the British Association of Dermatologists.


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