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Alopecia Areata: Types, Causes, Symptoms, and Treatment

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Alopecia Areata is a prevalent autoimmune disorder that often causes unpredictable hair loss. It affects an estimated 6.8 million people in the United States alone.

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This condition can cause hair to fall out in small patches, which can be unnoticeable except when the spots connect and then become noticeable.

In most of the instances, hair falls out in small patches around the size of a quarter, while for some, the hair loss is nothing more than a few patches, though in some cases it can be very severe.

The condition occurs when the immune system fights the hair follicles, which can trigger sudden hair loss, which can occur on the scalp, and in some cases the face, eyebrow, and eyelashes, as well as other body parts. It can emerge slowly and recur after years periodically.

The condition can cause total hair loss, which is known as alopecia universalis, and it can deter hair from growing back. When hair does grow back, it’s also possible for the hair to fall out again. The extent of hair loss and regrowth can differ from person to person.

There’s currently no known cure for alopecia areata. However, some treatments can enhance quick hair growth, and that can also prevent future hair loss, as well as different ways to cover up hair loss. Ways are also available to help people cope with stress related to hair loss.

The condition can happen to anyone regardless of age and gender, but most cases occur before age thirty. In this article, we intend to look at the causes and symptoms of alopecia areata, as well as its diagnosis and potential treatments.

One in five persons with alopecia  also has a family member who has suffered from the condition. Alopecia usually develop rapidly, for just a few days.

There is little scientific evidence to support the claim that alopecia areata can be as a result of stress. People suffering from alopecia who experience only a few patches of hair loss can sometimes make spontaneous, full recovery without the need for any treatment.

Types of Alopecia

There are different types of alopecia areata. Each type is categorized by the extent of hair loss and other symptoms one may experience.

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Each type also has a slightly distinct treatment and prognosis.

  • Alopecia areata (patchy): This is mainly characterized by one or more coin-sized patches of hair loss on the skin or body. If this symptom gets worse by expanding, it ha developed into alopecia totalis or alopecia Universalis.
  • Alopecia totalis: Alopecia totalis is characterized by total hair loss across the entire scalp.
  • Alopecia Universalis: This type of alopecia universalis, in addition to losing hair on the scalp, people with this type of alopecia areata will also lose all the hair on their eyebrows and eyelashes. It’s also possible to lose hair on other body sites like the chest, back, and pubic hair.
  • Diffuse alopecia areata: Diffuse alopecia areata can look a lot like a female- or male-pattern hair loss. It results in sudden and unexpected hair thinning all over the scalp, not in just one patch or area.
  • Ophiasis alopecia: Hair loss that follows a band along the lower back or the sides of the scalp is called ophiasis alopecia.
  • Telogen effluvium: A reversible condition in which the hair falls out as a result of stress.
  • Anagen effluvium: This is an anomalous loss of hair during the first phase of the hair growth.

Causes of alopecia areata

The condition occurs when white blood cells fight against the cells in the hair follicles, causing them to shrivel and slow down hair production. The precise reason why the body’s white blood cell attacks the hair follicles in this way is still unknown.

Alopecia areata is an autoimmune condition. An autoimmune condition develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends one’s body against foreign invaders, such as viruses and bacteria.

If one has alopecia areata, however, one’s immune system mistakenly attacks one’s hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss.

Researchers don’t know the exact cause of this condition. There are also beliefs that chilbirth can cause Alopecia. While scientists are uncertain why these attacks occur, it seems that genes are involved as alopecia is more probable to happen in a person who has a family member with the disease.

One in every five people with the condition has a family member who has also suffered from alopecia. Also, it most often occurs in people who have a family history of other autoimmune conditions, such as type 1 diabetes or rheumatoid arthritis.

This is why some scientists suspect that genetics may contribute to the development of alopecia areata. They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to it.

Other research has discovered that a lot of people with a family history of alopecia also have a personal or family history of other autoimmune disorders, such as thyroiditis, atopy, and vitiligo.

Despite what many people think, there not enough scientific evidence to support the belief that alopecia can be caused by stress; Although scientists are not ruling out that severe cases of stress could potentially cause the condition, but most recent research points toward a hereditary cause.

Symptoms

The most conspicuous symptom of alopecia is patchy hair loss. Quarter-sized patches of hair begin to fall out, from the scalp or any other site of hair growth such as the eyebrows, pubic parts, or even the beards.

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The loss of hair can develop rapidly, like in just a few days or in a few weeks. One may experience itching or burning in the area before the hair falls out. The hair follicles are not usually damaged, and so hair can regrow if the inflammation of the follicles abates.

Persons who experience just a few patches of hair loss can experience a natural, full recovery without any form of treatment. Thirty percent of individuals who suffer from alopecia will learn that their hair loss becomes more serious or becomes a continuous cycle of hair loss and regrowth.

About half of persons who suffer from this condition will recover from it within a year, but many will suffer reoccurring episodes, and an estimated 10 percent of people with alopecia areata will go on to develop either alopecia totalis or alopecia Universalis.

The major indication of alopecia is hair loss. Hair usually falls out in small patches on the scalp. These patches can often be less or about several centimeters.

One can also experience hair loss on other parts of the face, like the beards, eyelashes, and eyebrows, and other parts of the body like the pubic hair. Some persons lose hair in a few spots, while others experience hair loss in a lot of body sites.

One may first notice alarming strands of hair on one’s pillow or in the shower. If the spots are on the back of one’s head, someone may bring it to one’s attention. However, other health conditions can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata.

In some rare cases, some persons may experience more substantial hair loss. This is usually a sign of another type of alopecia that is not alopecia areata, which can be either alopecia totalis, which is the when all hair on the scalp falls out or alopecia universalis, which is when one experience loss of hair on the entire body

Doctors might avoid using the terms “total” and “universal” to classify the condition because some people may experience something in between both. One can lose all hair on the face, chest, and scalp, but not on the arms, for instance.

The hair loss associated with alopecia areata is erratic and cannot be predicted and, as far as researchers and doctors can tell, appears to be spontaneous. The hair may regrow at any point and then fall out again.

The extent of hair loss and regrowth can vary greatly from person to person.

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Alopecia areata in males

Alopecia areata can happen to both men and women, but the loss of hair is likely to be more significant in men. Men are also more likely to have a family history of this hair loss disorder.

Men may experience hair loss of facial hair, as well as back, chest, and scalp hair. Compared to male-patterned baldness, which is the gradual thinning of hair all over, hair loss from this condition causes patchy hair loss.

Alopecia areata in females

Females are more likely to suffer alopecia areata than males, but it’s unclear why. The hair loss can be on the scalp, as well as the lashes and eyebrow.

Different from female-pattern hair loss, which is a gradual thinning of hair that covers a large area, alopecia areata may be restricted to a small area. The hair loss may develop rapidly all at once, too. The area can gradually expand, which can cause greater hair loss.

Alopecia areata in children

Children can suffer from this disorder. In fact, most persons with the condition will experience signs of alopecia areata before the age of 30.

While alopecia areata can be hereditary, parents with the condition don’t always pass it on to a child, and children with this type of condition may not have a parent who has it.

In addition to hair loss, children with alopecia may experience other symptoms like nail defects, such as pitting or lesions. Adults can also experience this symptom, too, but it’s more common in children.

According to reports by The National Alopecia Areata Foundation, children younger than age five usually don’t experience much of emotional trauma from alopecia. After age 5, they can, however, be traumatized by hair loss as they can notice how they’re different from others.

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If one’s child appears stressed or depressed, ask a pediatrician to recommend a counselor experienced with children. Alopecia can also affect the fingernails and toenails, and sometimes these changes are the first sign of developing the condition.

Alopecia symptoms are usually the same in both men and women and there are several other small changes that can occur to the finger and toenails:

  • Pinpoint dents appear
  • White spots and lines can appear on the nails
  • Nails can appear rough
  • Nails lose their shine and adopt a dull look
  • Nails become thin and split

Additional clinical signs can include:

  • Exclamation mark hairs can occur when few short hairs that get thinner at their root and grow around or in the edges of patchy spots.
  • Cadaver hairs: This is when growing hairs break before reaching the skin surface.
  • White hair: This may grow in areas affected by hair loss.

Alopecia areata prognosis

The prognosis for alopecia areata can differ from person to person and can also be very unpredictable.

When one develops this autoimmune disorder, one will have to live with bouts of hair loss and other related symptoms for the rest of one’s life, although some persons may, however, experience hair loss just once.

The same disparity applies to recovery: Some persons will experience full regrowth of hair. Others may not. They can even experience additional hair loss.

In people with alopecia areata, poor results are linked with several determinants:

  • Having multiple autoimmune conditions
  • Extensive hair loss
  • Early age of beginning of alopecia
  • Nail changes
  • Family history

How is alopecia areata diagnosed?

Doctors are usually able to diagnose alopecia areata easily by accessing symptoms. They might pay attention to the degree of hair loss and check hairs from affected areas under a microscope.

If, after this initial examination, the doctor is not able to make a diagnosis, they can carry out a skin biopsy, and if the need to rule out other autoimmune diseases arises, they might carry out a blood test.

As the signs of alopecia areata are so distinctive, diagnosis is usually quick and straightforward.

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One’s doctor may also perform a scalp biopsy to rule out other possible conditions that cause hair loss, like a fungal infection like tinea capitis. To carry out a scalp biopsy, the doctor will have to remove a small piece of skin from one’s scalp to analyze.

Blood tests can also be conducted if other autoimmune conditions are suspected.

The type of blood test carried out depends on the particular disorder suspected by the doctor. However, a doctor will usually test for the presence of one or more abnormal antibodies.

If these antibodies are found in the bloodstream, it usually indicates that one has an autoimmune disorder.

Blood tests that can help ascertain the condition by ruling out other conditions can include the following:

  • Diet: Foods with a high level of sugar, processed snacks, and alcohol can increase inflammation and irritation within the body.
  • Antinuclear antibody test
  • C-reactive protein and erythrocyte sedimentation rate
  • Testing the thyroid hormones
  • Examining the iron levels
  • Free and total testosterone
  • Follicle-stimulating and luteinizing hormone

Treatments

There’s no cure for alopecia, but there are treatments that one can try that help hair grow back more quickly or that be able to slow down future hair loss, and one can get a hair replacement surgery.

The disease is not easily predictable, which means it may require a large number of trials with drugs until they can find something that works for one.

For some people, hair loss may still, even while on treatments. The most well-known type of alopecia treatment is the use of corticosteroids, which are potent anti-inflammatory medications that can subdue the immune system.

These are most usually administered through local injections, topical ointment application, or orally.

Types of Medical treatments

Topical agents

One can rub medications into the scalp to help trigger hair growth. Several types of drugs are available, both over-the-counter (OTC) and by prescription:

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  • Minoxidil (Rogaine) is available over-the-counter and should be administered twice daily to the scalp, eyebrows, and beard. It’s considered safe, but it can take about a year to see the effects of the medication. There is evidence to indicate that it’s only useful for people with not severe case alopecia.
  • Anthralin (Dritho-Scalp) is a medication that irritates the epidermis to stimulate hair regrowth.
  • Corticosteroid creams like clobetasol (Impoyz), ointments, foams, lotions, and are believed to work by reducing inflammation in the hair follicle.
  • Topical immunotherapy is a procedure wherein a chemical like diphencyprone is administered to the skin to spark an allergy rash. The rash, which looks like poison oak, can induce new hair growth within six months, but the patient will have to continue the treatment to maintain the regrowth.
  • Injections: Steroid injections are a common alternative for mild, patchy alopecia to help hair grow back on bald spots. Steroids are injected with tiny needles into the bare skin of the bald areas.The treatment has to be repeated between one to two months to regrow hair, although this doesn’t prevent new hair loss from occurring.

Oral treatments

  • Cortisone tablets are sometimes used for severe cases of alopecia, but due to the likelihood of side effects, one should discuss this option extensively with a doctor.
  • Oral immunosuppressants, like cyclosporine and methotrexate, are another choice one can explore. They work by screening the immune system’s response. Still, they can’t be administered for an extended period of time due to the chances of side effects, which can range from high blood pressure to liver and even kidney damage and a heightened risk of severe infections and a type of cancer called lymphoma.

Light therapy

  • Light therapy is also known as photochemotherapy or phototherapy. This is a type of radiation treatment that employs a combination of UV light and an oral drug called psoralens to treat alopecia.

Natural treatment

Some people suffering from alopecia pick other therapies to treat their condition. These alternative therapies can include:

  • Administering vitamins, like zinc and biotin
  • Essential oils like tea tree, rosemary, lavender, and peppermint and other oils, like olive, castor, coconut, and jojoba can be administered.
  • Aromatherapy
  • An anti-inflammatory diet also called the “autoimmune protocol,” which is a restrictive diet that essentially includes meats and vegetables
  • Acupuncture
  • The use of probiotics
  • Micro-needling
  • Low-level laser therapy (LLLT)
  • Aloe vera drinks and topical gels
  • Administering of onion juice on the scalp
  • Scalp massage
  • Supplementing with herbs, such as ginseng, green tea, Chinese hibiscus, and saw palmetto

Although it is worthy to note that the effectiveness of alternative therapies in treating hair loss cannot be vouched for, and, the Food and Drug Administration (FDA) doesn’t require supplement makers to show evidence that their products are safe for using the claims on the supplement labels can sometimes be inaccurate and misleading.

It’s recommendable to talk to a doctor before trying any herbal or vitamin supplements. The effectiveness of each treatment can vary from person to person. Some persons won’t need treatment because their hair grows back on its own.

In some cases, however, some persons won’t see improvement despite using every treatment option available. One might need to try more than one treatment to examine the difference. Keeping in mind that hair regrowth can also be temporary as sometimes the hair can grow back and then fall out again.

The hair has other functions apart from its aesthetic aspect, and hair affords a form of shield against the elements such as the sun.

People with alopecia areata who wants the protective qualities of hair can:

  • Use sunscreen when exposed to the sun rays.
  • It is advisable to wear wraparound glasses to shield the eyes from the sun and dirt, which the eyebrows and eyelashes usually protect against.
  • Use headwear such as scarves, hats, and wigs to protect the scalp from rays from the sun or keep one’s temperature warm.
  • One can apply ointment inside the nostril to keep membranes moist and to protect against pathogens that are usually trapped by nostril hair.

Alopecia cannot directly make people sick, nor is it contagious. It can, however, be difficult to cope with emotionally. For many people, alopecia is a traumatic disease that warrants emotional treatments such as therapy and counseling.

Support and counseling groups are available for people to express their thoughts and feelings, and to discuss common psychological reactions to the condition

Alopecia has been likened by some persons to vitiligo, an autoimmune skin disease where the body fights against melanin-producing cells, which results in white patches on the skin.

Research results have suggested that these two conditions may share identical pathogenesis, with similar types of cytokines and immune cells driving the diseases and common genetic risk factors.

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As such, any new discovery on the treatment or prevention of any of both diseases may have consequences for the other. A number of documented cases where treatment for alopecia using diphencyprone (DCP), a contact sensitizer, has led to the development of vitiligo that has arisen over the years.

Preliminary studies in animals have found that quercetin, a naturally occurring bioflavonoid that can be sourced from fruits and vegetables, can reduce the risk of developing alopecia and can also effectively treat existing problems of hair loss.

Additional research is required, including human clinical trials, before quercetin can be considered a treatment option for alopecia.

Prevention

Prevention of Alopecia is impossible because the cause of the disorder is still not known.

This autoimmune disorder can be the result of several factors that can include family history, other autoimmune conditions, and even some skin conditions. But not everyone with all or some of these factors will develop the hair condition.

That’s why preventing it isn’t yet possible.

How to cope with living with alopecia

Alopecia can take an emotional toll on people, especially when hair loss affects the whole scalp. Some persons with this condition may feel alone and can spiral into depression.

It’s important to know that more than 5 million people trusted Source in the United States has alopecia areata. There are lifestyle changes one can adopt to help one cope with the condition.

The National Alopecia Areata Foundation has an online shop where they sell hair accessories and products which can be of help to anyone searching for help with wigs, eyelash extensions, or eyebrow stencils. Some Wig companies like Godiva’s Secret Wigs also have online video tutorials for help with care and styling.

Physically active teens and young adults with completely bald heads can add suction cups to wigs and hairpieces, so the wig doesn’t fall off while engaging in sports activities.

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New advancements in wig technologies, like the development of the vacuum wig, which is manufactured from silicon and a suction base, can help people with alopecia to even swim with their wigs still in place, although Vacuum wigs are more expensive than regular wigs.

If hair loss affects the eyebrows, eyebrow tattoos, microblading, and eyebrow pencil are a few alternatives to contemplate and one can learn how to enhance facial hair growth.

Microblading is a tattooing technique that can be semi-permanent, which fills in the eyebrows using hairlike strokes. It looks better than traditional eyebrow tattoos and lasts for as long as from one to three years.

A channel on youtube RedTube is full of makeup tutorials on how to fill in and style one’s eyebrows. Both genders who lose their eyebrows can learn how to fill them in with real-life video tutorials, like this one.

Eyelash extensions are difficult to apply when one doesn’t have a surface for them to adhere to, but one can find a few tutorials online on applying for eyelash extensions when one doesn’t have any eyelashes of one’s own. Here’s one example.

Diet

Some persons with a diagnosed autoimmune condition can consider following an “anti-inflammatory” diet. This type of eating plan is formulated to help cut down the autoimmune response in the body and lessen the chances of another hair loss episode or further hair loss.

To do that, one eats foods that are known to ease the inflammation process.

The foundational foods of this diet, also called the autoimmune protocol, are grains, vegetables, and fruits like blueberries, tomatoes nuts, apple seeds, broccoli, beets, oranges, and lean meats like wild-caught salmon.

Eating a balanced diet is beneficial to one’s overall health for many reasons, not just as a means of reducing inflammation.

References;

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  1. Alopecia areata; MNT, WMD
  2. Treatments for Alopecia Areata; NAAF, Healthline, MNT
  3. Causes, types and prevention of Alopecia Areata; WMB Healthline, MNT,
Alopecia Areata
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Jennifer Aigbini
I am a language enthusiast, studying Linguistics at the University of Benin, in Nigeria.
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