Alopecia Areata (AA): Causes, Patterns, Investigations, Treatment

Alopecia Areata (AA) is an autoimmune condition of the skin, which affects all the skin which grows hair. Alopecia areata is characterized by non-scarring hair loss in localized regions of the skin. It is rarely associated with other medical problems. The bald patches formed as a result of alopecia areata commonly have spontaneous hair re-growth in them. Alopecia Areata (AA) usually occurs in adults between the age of 30 and 60. It rarely affects toddlers. It occurs rarely in children who are below 3 years. This condition is often hereditary. Alopecia areata is not a contagious condition. It affects both men and women.

There are many treatments available, but they are not always beneficial. In many cases alopecia areata resolves without any treatment; whereas is some cases the hair loss can be permanent.

According to new research, the cause of alopecia areata is immune system abnormality, due to which the body’s immune system mistakenly attacks its own tissues, such as hair follicles resulting in disrupted hair formation. Biopsy taken of the affected skin shows immune lymphocytes within the hair bulb. Alopecia areata could sometimes be related with other autoimmune disorders, such as vitiligo, thyroid disease, rheumatoid arthritis, lupus and ulcerative colitis. Alopecia areata also has a strong tendency to occur within family members, thus there is a strong genetic factor to it.

• Presence of one or more well-defined patches of hair loss is the commonest pattern.
• Another pattern is diffuse alopecia areata where there is more generalized hair loss throughout the scalp.
• Sometimes, there is complete hair loss, which is known as Alopecia Totalis.
• Alopecia Universalis is a condition where there is loss of complete hairs present on the entire body. However, this condition is rare.

• Examination of the scalp shows a well-defined area/ areas of hair loss and bald skin, which is characteristic of alopecia areata.
• Biopsy can be done to further confirm the diagnosis.
• Other findings which can help with diagnosis are: presence of short hairs indicating fractured hairs, yellow regions of skin deposition at the site of follicle, frail and grey hairs in the bald area.

• There are various treatments available, such as steroid creams, shampoos, lotions and steroid injections; however, there is no sure shot treatment for this condition.
• There is no known effective preventative method also. However, reducing stress seems to help. There haven’t been any medicines or hair-care products, which are thought to be related or responsible for Alopecia Areata (AA).
• The course of hair loss is unpredictable. There are also chances of re-growth of hair on its own. However, if the duration of hair loss is more and the area involved is large, then the likelihood of hair re-growth is less.
• Limited success has been achieved with treatment for severe hair loss with corticosteroids (clobetasol/ fluocinonide), corticosteroid injections, cream etc.
• Steroid injections are given in the site of hair loss on the scalp or in the eyebrow region for loss of eyebrow hair.
• Other medications such as mometasone and minoxidil ointment, irritants like anthralin/topical coal tar, and topical immunotherapy with cyclosporine and different combinations of all these are also used.
• Topical corticosteroids in the form of cream or ointment take longer time to work, as they are not able to penetrate the skin deeply or sufficiently to reach the hair bulbs.
• Oral corticosteroids help in reducing the hair loss; however, these medications carry serious side effects.
• If the patches of hair loss are small then topical tacrolimus ointments (Protopic) can be beneficial. However, stress could trigger hair fall again.
• Studies have shown that diphenylcyclopropenone has shown considerable hair re-growth in many patients.
• The areas of hair loss can be camouflaged using cosmetics. Wigs can also be used, particularly in alopecia totalis.
• There is significant psychological effect on both men and women suffering from this disease, so it is important to counsel patients and see that they have good support system at home.