In a previous blog post we have discussed the issue of excessive, unwanted hair growth in females, commonly called Hirsutism. In this latest blog post we discuss another hair related issue, Alopecia Areata, also called patchy baldness.

Alopecia Areata is a condition in which hair loss occurs from some or all areas of the body, resulting in bald spots, most commonly on the scalp. The exact etiology of the condition remains unidentified. It presents itself in various forms with the hair loss being either temporary or permanent. It may occur anywhere on the scalp and may include multiple sites or a single bald spot. In a few cases, it may just involve the beard, sparing the scalp. In a few other cases, it involves all the body hair as well as the hair on scalp (it is then called Alopecia Areata Totalis, which is a rare condition). 

Etiology:

  • Alopecia Areata is known to be an auto-immune disorder, in which the body damages its own hair follicles, suppressing or ceasing their growth, leading to hair loss in patches
  • It has a hereditary and familial association, with a likelihood of running in families.
  • It may also be congenital (present since birth) or linked with genetic factors.

Signs, symptoms and clinical features:

  • The first sign towards developing the condition is when huge clumps of hair regularly fall off the scalp, resulting in smooth, round bald spots on the scalp.
  • The development of bald spots occurs slowly, over long durations of time.
  • These bald spots may acquire any shape, but are mostly round or oval.
  • The hair usually grows back over a period of several months, retaining the same texture and colour, in most cases. This hair is usually thinner and gray coloured .
  • In some cases, which includes, 10% of the total cases, the hair loss is permanent.
  • This condition typically affects the scalp, or the beard, but it may be seen anywhere on the skin, where there is presence of hair.
  • The underlying skin, beneath the bald spot, is completely normal and unscarred, with no signs of redness, inflammation or scarring. Sometimes, the hair that falls off leaves behind short stubs of hair, instead of a smooth bald area.
  • The disease does not pose any threats otherwise and the person is completely healthy. But, the area with hair loss can sometimes be tingling or painful.
  • The smooth bald area is more prone to sunburns due to the direct effect of sunlight.
  • It is not contagious and does not spread from person to person or site to site. However, different areas of skin exhibit hair loss and regrowth at the same time.
  • Alopecia is common in children, with the onset of the disease usually occurring in childhood itself.
  • It most commonly occurs in individuals between the ages of 20 to 40 years.
  • Alopecia occurs with an equal prevalence in both the sexes.

Diagnosis:

  • Alopecia is usually diagnosed on the basis of pre-listed signs, symptoms and clinical conditions.
  • Sometimes, additional tests or a biopsy may be needed, which also assist in the treatment of the condition.

Prevention and Treatment:

  • Usually the condition is temporary and hair grows back over a period of several months. There are phases of remission and regrowth, occurring simultaneously. No specific therapeutic or preventive treatments are known to be efficient.
  • In cases with severe hair loss, topical corticosteroids are used. The efficacy of the drug through the topical route is limited, so, it takes longer durations to show effective results. This occurs due to limited ability of the topical drugs to penetrate deeper into the layers of skin, where the hair bulb needs to be targeted in order to promote hair regrowth.
  • Thus, steroid injections are more commonly used, as they are absorbed quickly. They are directly injected into the area of the scalp with bald spots. Injectable steroids penetrate deeper into the skin and directly target the hair bulb. But, the efficacy of this treatment is still undetermined. Bald spots that are smaller in size are treated with injectable methods.
  • Injectable steroids are also used in cases involving Alopecia Areata in the eyebrows, forming small hairless patches.
  • Oral steroids are also used for the treatment of condition if it’s use is meritted. 
  • Other than various forms of steroids, a variety of drugs specific to hair loss and alopecia, are also available.
  • The commonest of these drugs is minoxidil, which is most commonly prescribed in cases of patchy hair loss.
  • Other drugs available are topical calcineurin inhibitors like tacrolimus.
  • You should always take medicines only when prescribed by a dermatologist.

Prognosis:

  • The disease is completely non-limiting. There is no loss of body functions. However, it is psychologically distressing, and becomes a common cause for anxiety and depression which is a matter of great concern.
  • Usually the hair loss begins with small number of patches and the hair grows back over a period of several months to a year.
  • When there are a greater number of patches, the hair can either grow back or progress on to Alopecia Totalis.
  • Even when the hair regrows, there are high chances of recurrence.
  • Recurrence does not occur in all cases.

Identify the root cause of Alopecia can be help treat it suitably. A dermatologist, with Remedico, will be able to help you understand the best options for you.

Do you have Alopecia Areata? With Remedico, you can consult with a certified dermatologist from wherever you are, all from your smartphone. We will send you a personalised treatment plan within 24 hours, and provide you with regular follow ups and answers to all your questions. Click the button below to consult our doctors.

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