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What is Alopecia Areata ?:
- Alopecia areata is a particular form of hair loss that can affect any part of
the body in either sex. The hair loss is noticed as a round bald area. There are
no other symptoms. The commonest site for alopecia areata is the scalp, but
frequently the beard area in men is affected. More rarely, eyebrows and
eyelashes are affected. In some individuals it can spread over the whole body,
when it is called alopecia universalis. Often, only a single area is found, but
sometimes multiple areas occur affecting different parts of the scalp or beard
area. The bald skin is smooth and soft, and small broken hairs may be seen at
the edge of the patch. Any age group can be affected.
How does Alopecia Areata occur ?
Alopecia areata is an “auto-immune” disease. This means a condition in which
the body's defense or immune system acts as if its own hair is abnormal and
attacks it. This results in hair loss. Why certain small areas are involved is
not known. It is occasionally found with other auto-immune diseases affecting
the blood, thyroid gland and adrenal glands, and skin pigment cells.
Why does Alopecia Areata occur ?
Alopecia areata may affect several members of your family, because the
tendency to it is partly inherited, exposure to toxins like pesticide, vitamin
deficiency, autoimmune process or a fungal or
bacterial infection. In some people, emotional stress or injury
to the involved area may trigger the problem.
Treatment Involved for Alopecia Areata
Common sense approach to the treatment is by treating the cause.
When the hair starts to grow, you may notice that the hairs are often fine
and white and may not be obvious in the mirror. With time, the hairs thicken and
darken and so become more easily seen. Occasionally, the hairs thicken but
remain white. Hair grows very slowly and it may take many months before the bald
patch becomes covered with hair. Alopecia areata affecting the beard area,
eyebrows and eyelashes tends to be slower to respond that the scalp disease. It
is important that you persevere with treatment. In some people, new patches
appear as the old ones regrow. These new patches should be treated as they come
up. In a small number of patients, the hair loss becomes extensive and does not
respond to any treatment.
After Treatment for Alopecia Areata
Once the patches have regrown, they are unlikely to go bald again. In some
patients, recurrent new patches develop at different sites over a period of
months or years. In some patients full recovery occurs, in others the condition
remains active and the hair fails to regrow.
If Alopecia Areata is Left Untreated
Alopecia areata may occur in other family members but this is unusual.
Patients with severe alopecia need considerable support from family and friends.
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- Corticosteroids--Corticosteroids
are powerful anti-inflammatory drugs similar to a
hormone called cortisol 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%)
(Rogaine*)--Topical minoxidil solution promotes hair
growth in several conditions in which the hair
follicle is small and not growing to its full
potential. Minoxidil is FDA-approved for treating
male and female pattern hair loss. It may also be
useful in promoting hair growth in alopecia areata.
The solution, applied twice daily, has been shown to
promote hair growth in both adults and children, and
may be used on the scalp, brow, and beard areas.
With regular and proper use of the solution, new
hair growth appears in about 12 weeks.
*Brand names included in this
booklet are provided as examples only, and their
inclusion does not mean that these products are
endorsed by the National Institutes of Health or any
other Government agency. Also, if a particular brand
name is not mentioned, this does not mean or imply
that the product is unsatisfactory.
- Anthralin
(Psoriatec)--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--When
drug treatments fail to bring sufficient hair
regrowth, some people turn to alternative therapies.
Alternatives purported to help alopecia areata
include acupuncture, aroma therapy, evening primrose
oil, zinc and vitamin supplements, and Chinese
herbs. 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. As with any therapy, it is best
to discuss these treatments with your doctor before
you try them.
The best
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Research studies are posted.
A 35-year-old woman presented with severe recalcitrant
atopic dermatitis, in association with disseminated
mollusca contagiosa and alopecia areata universalis.
After several weeks of systemic interferon gamma, which
was administered subcutaneously,the viral infection
cleared and, surprisingly, four weeks after starting
treatment hair re-growth was observed. Complete
remission of alopecia areata was documented few weeks
later and persists. After four cycles of high-dose
intravenous immunoglobulin, a sustained remission of the
atopic dermatitis was achieved.
J Dtsch Dermatol Ges. 2005 Jun;3(6):441-4
We report a patient with CVID and AU treated with IVIG
who experienced significant hair regrowth. An 8-year-old
girl with CVID and AU was treated with IVIG 400 mg/kg
every 4 weeks. Since her second dose of IVIG, regrowth
of eyelashes, eyebrows, body and scalp hair was observed
in this patient. At present, about 1 year treat-meant of
IVIG, significant hair regrowth is noted with 5-6 cm of
scalp hair. We believe that IVIG may be beneficial in
the treatment of AU, at least in patients with CVID.
Asian Pac J Allergy Immunol. 1999
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