Alopecia Areata

Alopecia areata is an autoimmune condition that causes sudden, patchy hair loss on the scalp, face, and sometimes other areas of the body including eyebrows, eyelashes, under arms and private parts. It occurs when the immune system mistakenly attacks hair follicles, leading to hair loss. The extent of hair loss varies, and in some cases, it can progress to complete baldness. It can cause immense psychosocial disturbances.

Causes of Alopecia Areata:

Autoimmune Response: The primary cause is the immune system attacking healthy hair follicles, as the white blood cells failed to recognise the hair follicle antigens as ‘self’ causing them to shrink and fall off.
Genetics: A family history of alopecia areata or other autoimmune disorders increases the likelihood of developing the condition.
Environmental Triggers: Factors such as viral infections, stress, or trauma can trigger or worsen the condition in genetically predisposed individuals. Infections are known to change the reactivity of the immune system.
Other Autoimmune Conditions: Alopecia areata is more common in individuals with other autoimmune diseases, such as thyroid disorders, vitiligo, Pernicious anemia or type 1 diabetes.

Symptoms:

Patient presents to us Patchy Hair Loss, Sudden, round to polygonal bald patches on the scalp, beard, eyebrows, or other body parts.

Exclamation Mark Hairs: Short hairs that taper at the base, often seen around the edges of bald patches. Though they are visible to the naked eye, they are difficult to recognise. A hair scan or trichoscope helps in diagnosing this kind of hair.
Nail Changes: Some people experience pitting, ridges, or brittle nails. Very rarely, it can lead to total loss of nails.

Types of Alopecia Areata:

Alopecia Areata (Patchy): The most common form, causing one or more coin-sized patches of hair loss.
Alopecia Totalis: Complete loss of hair on the scalp. Patchy hair loss when it is multiple patches, especially involving the borders of the scalp, if left untreated can progress to this variety.
Alopecia Universalis: Complete loss of hair on the scalp, face, and body. This is a more severe condition of necessitating psychological support.
Diffuse Alopecia Areata: Sudden thinning of hair rather than distinct bald patches. This type is difficult to recognise as it makes the other forms of hair loss like chronic telogen effluvium. Only an expert dermatologist with the help of Dermoscope can identify this condition.

Treatment Options:

Corticosteroids: Anti-inflammatory drugs can be applied topically, injected into bald patches, or taken orally to suppress the immune response. However, long-term use of topical corticosteroids can be associated with side-effects. You need to consult the dermatologist before using any of these medications.
Topical Immunotherapy: Chemicals like diphencyprone (DPCP) are applied to the scalp to provoke an allergic reaction, stimulating hair regrowth by diverting the immune attack. Sometimes the allergic reactions can be so severe that anti-inflammatory drugs and anti allergy medication may be necessary to control the inflammation. Topical SADBE and phenol are also used with good results.
Minoxidil : A topical solution that may help stimulate hair regrowth. However, usage of minoxidil alone is not recommended in treatment of Alopecia areata as the immune system needs to be addressed.
Oral Immunosuppressants: Drugs like methotrexate or cyclosporine can suppress the immune system, though they come with significant side effects.
JAK Inhibitors: Newer oral medications like tofacitinib and ruxolitinib show promise in reversing hair loss by targeting specific immune pathways. These are found very effective in managing severe forms of Alopecia areata and R safely used even in children. However, they require regular blood work up for monitoring.
Platelet-Rich Plasma (PRP) Therapy: Involves injecting a concentration of the patient’s own platelets into the scalp to promote hair growth. The results of PRP are variable. We do not recommend this treatment for Alopecia areata as the immune system needs to be addressed before treating the hair.
Hair and Scalp Care: Wearing wigs, hats, or scarves can protect sensitive skin and improve self-esteem. Supportive therapy is essential as the patient goes through a lot of psychological trauma.

Coping and Support:

Emotional Support: Alopecia areata can impact mental health; support groups and counseling can be helpful.
Stress Management: Techniques like mindfulness, yoga, and exercise can help reduce stress, which may exacerbate the condition.

Alopecia areata can be unpredictable, with cycles of hair loss and regrowth. While there is no cure, many treatments can help manage the condition and encourage hair regrowth. Consult our dermatologist at Subodha skin and cosmetic clinic, best dermatologists in Bengaluru for personalized treatment options and best results.