Alopecia areata is an autoimmune condition where the body’s immune system is attacking the hair follicles, causing the hair to fall out. The natural history of the condition is usually unpredictable with patches of hair loss occurring, followed by regrowth and then potentially further patches of hair loss occurring.
It is often referred to in the community as just ‘alopecia’ however this term should always be qualified with the word areata as there are other forms of alopecia such as scarring alopecia, androgenetic alopecia etc. The terms totalis and universalis are descriptive terms referring to loss of the entire scalp hair and loss of the hair on the entire body respectively.
Therefore, one would refer to these conditions as alopecia areata totalis or alopecia areata universalis to signify that these are particular presentations of the one condition, rather than a distinct entity.
Fortunately, the autoimmune-induced inflammatory response does not cause destruction of the hair follicle and so as the follicles are still present regrowth is always possible. This differs from some of the other hair loss conditions.
Alopecia areata affects approximately 4% of the population (90,000 in the UK alone), and around 98% of those diagnosed recover. Alopecia areata can affect all ethnic groups and ages, but is most likely to occur between the ages of 20 and 50.
It also occurs equally in both men and women.
The main diagnostic feature of alopecia areata is the presence of bald patches surrounded by little ‘exclamation mark hairs’.
They are thicker at the top and taper to a thinner end, with the root a blob at the bottom.The number of exclamation mark hairs you have can indicate how active the alopecia areata is. In general, the more there are, the more rapid its progress. However, sometimes there are no visible exclamation mark hairs at all. In these cases, alopecia areata may be diffuse (spread over a large area), but this is rare.
In alopecia there is also inflammation present at the lower end of the hair follicle, but you can’t see it. Rarely, small patches of alopecia areata can grow, overlap and progress to total baldness, or alopecia totatlis.
Alopecia areata is widely accepted to be an autoimmune disorder, where your body sees certain hair cells as foreign enemies and attacks them. What triggers this response isn’t entirely understood, but 90% of cases are associated with stress, shock, bereavement or an accident and/or illness.
There is also often a genetic predisposition and there are in fact several reported cases of alopecia areata’s occurrence in twins. Alopecia areata is also more common in those that suffer from hayfever, eczema, Addison’s disease, pernicious anaemia, rheumatoid arthritis, ulcerative colitis, lichen planus, diabetes mellitus, vitiligo, lupus and thyroid disease.
In many cases, alopecia areata spontaneously resolves itself within a year, but there are also treatments available to help bring about remission.
Corticosteroid injections are thought to be the most effective of treatments for alopecia areata, especially when used on small patches. They are given every few weeks, and can be used to treat bald areas on your scalp, eyebrows and body.
They suppress your body’s immune system, so that it no longer attacks your hair follicles.
Pain at the injection site and thinning of the skin.
The benefits of topical corticosteroids are debatable. They’re applied daily to affected scalp areas, but cannot be used on your face or body. Possible topical creams and gels include: betamethasone, hydrocortisone and mometasone.
Similar to corticosteroid injections, but applied differently.
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