Treatment for Alopecia Areata

Alopecia areata is a disease that happens when the immune system attacks hair follicles and causes hair loss. Hair follicles are the structures in skin that form hair. While hair can be lost from any part of the body, alopecia areata usually affects the head and face.

Its a common autoimmune disorder that often results in unpredictable hair loss.

Alopecia can affect anyone, regardless of age, gender, or race, though most cases develop before the age of 30.

What are the different types of alopecia areata?
There are many different types of alopecia areata. Most individuals lose hair in circles or patches, which is called alopecia areata. Individuals who lose hair all the scalp but retain hair elsewhere on the body are said to have alopecia totalis. Individuals with complete loss of hair all over the body have alopecia universalis.

There are many other unique types of hair loss. The ‘ophiasis’ form of alopecia areata specifically lose hair from the back and sides of the scalp. Men with alopecia areata barbae lose hair from the facial hair containing areas (beard, moustache).

Is alopecia a sign of an underlying disease?
Most individuals with alopecia areata are very healthy. A small proportion have other autoimmune conditions as well, including skin rashes (called eczema or atopic dermatitis), autoimmune thyroid conditions (especially hypothyroidism) or autoimmune pigment loss in the skin (called vitiligo). Other autoimmune conditions are occasionally seen but it is quite rare.

Does stress cause alopecia?
Stress does not directly cause alopecia areata for most… but can certainly can affect the condition for a small minority of individuals. For example, some individuals have noticed a patch of hair loss after periods of extreme (high level) stress.

Do I need a scalp biopsy?
Most individuals with alopecia areata do not require a scalp biopsy. Alopecia areata is said to be a ‘clinical diagnosis” which means the diagnosis comes about in most cases by closely examining the scalp of the individual with hair loss.

Can alopecai areata pass on to the next generaton?
Alopecia areata develops partly from the inheritance of various genes. These genes can be passed on from one family member to the next. But the genetics of alopecia areata is not as simple as how one inherits their eye color or hair color. The chance of a parent passing on alopecia areata is quite low for most people. As more and more family members and relatives are affected, the chance of passing it on does increase. Most individuals with alopecia areata do not have any other family members affected.

What treatments are available?
A variety of topical treatments, injection treatments and oral treatments are available. Topical steroids and steroid injections are frequently used as a first step and sometimes with topical minoxidil as well. Steroid injections are also very common, especially for those over 10-12 years of age. These injections are gievn at an interval of 3 to 6 weeks. Patients with greater amounts of hair loss or who do not respond to these first group of treatments may then start treatments such as diphencyprone or anthralin which are topical or immunosuppressant pills such as prednisone, methotrexate, sulfasalazine or tofacitinib.