The disease known as alopecia areata causes quick hair loss. It usually appears as patchy bald spots on the scalp, and in some cases can progress quickly until all body hair is gone.
Although the precise origins of alopecia areata are not known, medical researchers blame it on genetics. Several genes that are present in some, but not all, people can trigger an immune system response that targets the hair follicles, which are the shafts where hair grows on your scalp and other locations on the body. The immune system generates white blood cells that attack the follicles, causing them to shrink. This will slow hair production, and in some cases, halt it completely.
The change is not permanent because the stem cells, which supply the follicles with new cells, are not damaged by the white blood cell attacks. That leaves room for new hair to grow back. Unfortunately, in some cases, the hair grows back thinner or in a lighter color than previous hair growth.
The disease can strike at any age but mostly seems to attack people younger than age 20. Alopecia areata is an equal opportunity disease, attacking men and women in roughly equal numbers.
Alopecia areata can be a frustrating disease. There are no treatments, but drugs developed for other uses can help battle it. There is also no guarantee of hair regrowth. Some hair may sprout in the affected regions, only to fall out in another.
And an estimated 5 to 10 percent of the disease’s victims will never get their hair back. Those victims most unlikely to regain hair include those who are affected for more than a year, those who have a family history of the disease, pre-pubescent children and those with other autoimmune diseases.
Surgical Treatments for Alopecia
While no drugs on the market are specifically designed to treat alopecia areata, there are some that aim to promote hair regrowth. The downside is that the products must be used long term to make the hair growth permanent.
There are also surgical alternatives, in which sections of the scalp are tightened in the hairless regions to move the hair on your head closer together, giving the illusion of one seamless region. Then with styling, it can make it seem like there is not a problem.
It is also possible to have hair plug transplants. This involves surgical insertion of hair into the scalp, with hopes that the plugs sprout and grow, creating new regions of hair.
Drug Treatments for Hair Loss
Some adults prefer to treat alopecia areata with corticosteroids. This can be done either via direct injection, oral medications, or topical creams, foams, gels or other ointments.
The injections aim to affect the inflammation at the hair follicle level directly in doses that are spaced out over four to eight weeks. Oral treatments also work, but hair loss often may recur when treatment ceases. With creams, patients apply the ointment for about 20 minutes each day, then wash it off.
The drugs used include:
- Minoxidil - This was one of the first Food and Drug Administration-approved drugs for hair regrowth. It is administered in a solution of up to 5 percent minoxidil for men and a 2 percent solution for women. Minoxidil is designed to promote hair follicle growth, but the process is slow, taking up to 12 months. It must then be continued for life, or the hair will fall out again.
- Finasteride - The drug works on an enzyme that promotes hair growth and is generally applied topically once a day. This drug works faster than minoxidil, generally producing hair within six to eight months. But once treatment is stopped, so is the hair growth, and it results in renewed loss.
- Hormonal modulators - Spironolactone is a hormone that is effective in women with hair loss and is generally taken as an oral medication.
Although alopecia areata is painless, there are psychological and social issues that arise from sudden hair loss, particularly with younger people. It is important to let teachers, counselors, coaches and business associates know that the person is perfectly healthy except for the hair loss. Alopecia areata is not contagious and has no real consequences beyond the trauma of losing hair. Health issues may arise if the hair loss extends to other body hair, such as the eyebrows, nasal hair and eyelashes. But there are sprays available that can moisten the nasal membranes, and wearing sunglasses can help with keeping dust and dirt out of the eyes.
More significant for the patient -- particularly a younger patient -- is enduring the social stigma of sudden hair loss. Certainly there are hair pieces, wigs and other coverups like scarves, caps or hats that can help with the problem. However, if depression or anxiety is at issue, it is wise to have counseling available to deal with the problems that may arise. Because alopecia areata arrives suddenly, coping with its onset can be hard for a person. Talking about it with a trusted and experienced counselor can ease the burden. There are also support groups for alopecia areata that meet regularly, and several foundations are devoted to research and support for families and individuals.
Alopecia areata is an autoimmune disease, so doctors will look at potential problems with the thyroid, skin rashes, asthma and other allergies. They may request blood tests and other special examinations designed to eliminate concerns about any underlying problems.
As medical researchers begin to understand more and more of what causes autoimmune diseases and genetic research advances, there may be hope that alopecia areata eventually becomes a vanquished disease. For now, it remains a traumatic condition, but there are treatments that can help sufferers regain at least some lost hair.