Bruce P.Robinson, MD
Alopecia areata (AA) causes hair loss in small, round patches that may go away on their own, or may last for many years. Nearly 2% of the U.S. population (about four million people) will develop AA in their lifetime. Some people with AA (about 5%) may lose all scalp hair (alopecia totalis) or all scalp and body hair (alopecia universalis). It is an autoimmune disease, in which for unknown reasons your immune system attacks your own hair follicles, (where the hair grows from), resulting in damage that leads to hair loss anywhere on the body. Typically, it affects small patches of hair so, it may go completely unnoticed. However, more patches of hair loss could develop close together, making it more noticeable.
AA occurs world-wide in both genders and in every ethnic group. Children and young adults are most frequently affected, but persons of all ages are susceptible. One in five persons with AA has a family member who also has the disease.
AA usually begins with one or more small, round, coin-size, bare patches. It is most common on the scalp, but can involve any hair-bearing site on the body including eyebrows, eyelashes, and beards. Hair may fall out and regrow with the possibility of full hair regrowth always present. AA usually has no associated symptoms, but there may be minor discomfort or itching prior to developing a new patch. Nails may have tiny pinpoint dents, ridges, become brittle and may, in rare instances, become distorted.
AA is not contagious. It is an autoimmune disease in which the body's immune system attacks itself, in this case, the hair follicles. The cause is not known. A person's particular genetic makeup combined with other factors triggers AA.
The main types are:
Alopecia areata: Alopecia is the medical term for bald. Areata means patchy. This patchy baldness can develop anywhere on the body, including the scalp, beard area, eyebrows, eyelashes, armpits, inside your nose, or ears.
Alopecia totalis: The person loses all hair on the scalp, so the scalp is completely bald.
Alopecia universalis: The person loses all hair, leaving the entire body hairless. This is rare.
Although your dermatologist may know by examining your scalp that you have AA, occasionally, a scalp biopsy is helpful in confirming the diagnosis.
Because there are so many reasons for hair loss, testing is sometimes necessary to make sure alopecia areata is the cause of your hair loss.
A blood test can look for other diseases caused by the immune system. Sometimes, other tests are necessary.
AA is not a symptom of a serious disease and usually occurs in otherwise healthy individuals. Persons with AA may have a higher risk of atopic eczema, asthma, and nasal allergies, as well as other autoimmune diseases such as thyroid disease (Hashimoto's thyroiditis), and vitiligo. Family members may also have atopic eczema, asthma, nasal allergies, or autoimmune diseases (i.e. insulin-dependent diabetes, rheumatoid arthritis, thyroid disease, or systemic lupus erythematosus).
Yes, it is likely that the hair may regrow, but it may fall out again. The course of the disease varies from person to person, and no one can predict when the hair might regrow or fall out again. This unpredictability of AA, and the lack of control over it, makes this condition frustrating. Some people lose a few patches of hair, the hair regrows, and the condition never returns. Other people continue to lose and regrow hair for many years. The potential for full regrowth is always there, even in people who lose all the hair on their scalp and body (alopecia totalis/universalis). Hair could regrow white or fine, but the original hair color and texture may return later.
The good news is that many causes of hair loss can be managed when caught early and further loss can usually be slowed or prevented.
Corticosteroids are anti-inflammatory drugs that suppress the immune system. They can be given as injections into the areas of hair loss, rubbed topically into affected areas or taken orally as pills.
Oral Minoxidil is by prescription only. Dermatologists began using low-dose oral minoxidil for hair loss after noticing the side effects of the high-dose version of the drug used to treat high blood pressure increased hair growth. The efficacy of 5mg oral minoxidil for men with androgenetic alopecia was tested. Researchers concluded that 43% of the patients had excellent results in hair growth. Typically, people prefer oral to topical. They find it easier and more convenient to take the medication orally, may be able to save money with an oral minoxidil prescription and prefer not to have residue on their hair.
Topical Minoxidil 5% Solution aka Rogaine solution or foam is available over the counter. Effectiveness of topical Minoxidil works for about 2 out of 3 men. It's most effective if you're under age 40 and have only recently started to lose your hair. How to use it: Twice a day, when your hair is dry, apply minoxidil on your scalp where the hair has started to thin. Minoxidil can help maintain the regrowth after you stop applying the corticosteroid. It has few side effects, so it’s considered a good option for children. New hair growth may appear in about 12 weeks.
PRP (platelet-rich plasma) therapy for hair loss is a three-step medical treatment in which a person’s blood is drawn, processed, and then injected into the scalp.
PRP injections trigger natural hair growth and maintain it by increasing blood supply to the hair follicle and increasing the thickness of the hair shaft. Sometimes this approach is combined with other hair loss procedures or medications.
PRP therapy is a three-step process. Most PRP therapy requires three treatments 4–6 weeks apart.
Maintenance treatments are required every 4–6 months.
Your blood is drawn — typically from your arm — and put into a centrifuge (a machine that spins rapidly to separate fluids of different densities).
After about 10 minutes in the centrifuge, your blood will have separated into in three layers:
The platelet-rich plasma is drawn up into a syringe and then injected into areas of the scalp that need increased hair growth.
There hasn’t been enough research to prove whether PRP is effective. It’s also unclear for whom — and under what circumstances — it’s most effective.
Wigs, caps, hats, or scarves are important options. Wearing a head covering does not interfere with hair regrowth. This may be a good choice for people with extensive scalp hair loss who do not have enough hair to cover it.
The emotional aspects of living with hair loss can be challenging, especially in a society that regards hair as a sign of youth and good health. It is reassuring that alopecia areata does not affect general health, and should not interfere with your ability to achieve all of your life goals at school, in sports, in your career, and in raising a family.
The National Alopecia Areata Foundation, the NAAF, is a great resource for support, treatment & education.
Schedule an appointment to see which treatment or combination of treatments is the best choice for you.
