Alopecia Areata: Definition, Causes & Treatments

Are you suffering from alopecia? Listen to what a dermatologist has got to say on it. We have good news.

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What is hair loss?

Shedding of hair is a natural phenomenon. It is usual for an individual to shed 50-100 hairs daily, which are then replaced with new hair. However, sometimes, shed hair is not replaced with new ones, leading to thinning hair and the formation of bald patches.

“Alopecia” is the medical term generally used for it. It has various types, Telogen Effluvium is one of them(1).

Will the hair loss grow back?

Alopecia can occupy a large number of someone’s thoughts and mindshare because it is a deformity one can see. It changes one’s perception of oneself, self-confidence, and mental health.

Experts insist on reaching out for professional health instead of letting this affect one’s health. But, one good news is that majority of the stray hair strands will grow back.

According to Hogan, “This hair fall improves over time. It is not a permanent hair fall disorder and gets better within 4-6 months.”

Agreeing with Hogan’s point of view, Poland says’ “This type of alopecia tends to improve over time. Improvement can be variable. Some will see all their hair return, while others will experience patchy regrowth. In all cases, like other medical illnesses, hair will regrow.”

What causes alopecia?

Alopecia is a complex phenomenon that is not yet fully understood. Several different factors contribute to hair fall in humans by altering different stages in the hair cycle.

Androgenic alopecia is the most common form of alopecia. It is also called male or female pattern baldness. Commonly known causes of hair fall include:

Seasonal variation

The hair cycle varies with seasonal variation due to changes in day length and certain hormone levels. As a general trend, hair fall is more significant in winters and spring as compared to summers.

Aging

Hair loss is also associated with the aging process. As we age, thinning of hair occurs due to decreased mean hair density and growth rate. Gray hair can also tell you a lot about your health.

Nutritional imbalances

Several vitamin and mineral deficiencies are linked to alopecia. Most of the conducted describe the association of Zinc, Vitamin D, and protein.

Both too little and too much zinc has harmful effects. The addition of mild amounts of zinc to diet is associated with substantial improvement of skin and hair.

Similarly, Iron and Vitamin D are also known to regulate hair growth.

Hormonal imbalances and changes

The hormonal imbalance also has an established role in alopecia. High levels of dihydrotestosterone, due to any reason, promote hair fall. Common causes of hormonal imbalances/changes include pregnancy, postpartum, menopause, hypothyroidism, and Hyperadrenocorticism.

Bacterial infections

Bacterial infections like staphylococcus cause inflammation and pruritis, resulting in alopecia.

Parasitic infections

Fungal infections are associated with pruritis and consequent loss of hair. Tinea capitis is a common fungal infection that causes scalp eruptions and alopecia.

Atopic dermatitis

Atopic dermatitis is a chronic skin condition precipitated by exposure to allergens like dust mites or cleaning agents. It is associated with pruritis that causes secondary bacterial infections resulting in alopecia.

Stress

There are several studies that support the association of stress with either the onset or exacerbation of alopecia. Stress induces inflammatory cellular responses that inhibit hair formation and accelerates maturation and loss of hair.

Psychiatric disorders

Various psychiatric disorders leading to self-induced alopecia or hair-pulling by others also contribute to alopecia.

Drugs and medications

Certain drugs like those used to treat cancer, depression, and hypertension also promote alopecia(1,2).

You might have heard of doctors talking about alopecia but you have little knowledge of what it is. Well, it might be the cause of your alopecia after all.

What is alopecia areata?

Alopecia areata is an autoimmune disease in which antibodies attack the body’s hair follicles, resulting in hair loss. Though about 85 percent of Males have to experience baldness in their later life, alopecia areata is quite different from this.

Unlike pattern baldness, hair loss occurs at every age. It affects the body in patches, and at times these patches unite to form a big patch, eventually resulting in total body alopecia. It is important to note that the hair follicles remain preserved in this disease. (Herbert Pratt et al. 2017)

Unlike the typical baldness pattern that affects the scalp, the alopecia areata affects the different skin patches (Lepe and Zito 2020).

Most of the time, these patches remain unnoticed or heal without any treatment, but sometimes they become noticeable and unite to form a big patch or result in total body alopecia.

How many kinds of alopecia are there?

It is a common condition and has affected about 7 million people in the United States. Based on the signs and symptoms, we usually divide alopecia broadly into the following types.

1. Alopecia Areata, in which there is patchy loss.
2. Alopecia Totalis, in which there is loss on the entire scalp.
3. Alopecia Universalis in which there is loss on the entire body.
4. Diffuse Alopecia Areata involves the thinning of hair of the entire scalp.
5. Ophiasis Alopecia involves the band-like loss of hair in the lower part of the scalp.

Hair loss develops suddenly in weeks and days resulting in thinning and inflammation of hair follicles. The good thing regarding this pathology is that the patient gets recovered once the inflammation gets settled.

To date, we are unable to find the real cause behind the alopecia areata. Researches only prove the autoimmune nature of disease related to diabetes, stress, and other immune-mediated diseases.

How doctors diagnose hair loss?

Hair loss increases naturally with age. However, in some cases, it indicates an underlying health condition.  The best way to diagnose and find its cause is to consult a medical doctor who will diagnose by taking history regarding:

• Type, onset, and duration of hair fall
• Any pre-existing medical condition
• Family history
• Intake of any medications
• Haircare routine
• Diet

Afterward, a physical examination might include a pull test to determine the hair fall.

The third step includes microscopic laboratory examination of the collected hair sample.

Finally, other associated health conditions are diagnosed/identified by carrying out blood tests of the patient.

When to consult a doctor over alopecia?

It’s never too early to consult a doctor! And, if you’re distressed about hair loss, book an appointment immediately. Some signs indicate an underlying medical condition that needs prompt treatment. Following signs call for an immediate consultation:

•         Sudden onset of hair loss
•         Hair falling out in clumps
•         The appearance of bald patches on the scalp
•         Hair fall accompanied by scalp itching
•         Hair fall accompanied by scalp tenderness

What are the treatments for alopecia?

It is usually said that there is no cure for Alopecia Areata. It might be right, but the good thing is that it can resolve once the inflammation gets settled.

The hair starts growing again on the affected part once the inflammatory reaction gets resolved. We usually focus on hair growth so that the new hair starts proliferating.

Medical treatments for hair loss

Like all other conditions, treatment for hair fall depends on its cause. The cause might be a local infection or an underlying systemic medical condition requiring prompt treatment.

Specific anti-cancer or anti-hypertensive drugs also cause alopecia requiring a change in medication or complete stoppage for a few months.

Drugs

A dermatologist might prescribe one of the following drugs to treat hair loss:

Minoxidil

The best topical regimen is the prescription of an immune suppressor ointment, a hair growing spray (Minoxidil), and some steroid ointments to suppress the inflammatory reaction(Hordinsky 2015).

Spironolactone

Spironolactone is used to treat female pattern baldness involving hairline recession and vertex balding. It reduces hair loss and improves hair thickness.

Finasteride

Finasteride inhibits the production of male hormone (testosterone) and helps treat alopecia. It slows the rate of hair fall and promotes the growth of new hair.

Corticosteroid Injections

Injecting corticosteroids into bald patches or areas of hair thinning also helps treat certain types of hair loss.

Hair transplants

During a hair transplant, a dermatologist removes hair from one part of the body and transplants it on the scalp.

Immune modulators

The latest approved treatment for hair loss is the immune modulators tofacitinib and ruxolitinib prescribed these days.

Home remedies for hair loss

People have been using home remedies to treat it for ages. However, it is recommended to consult a doctor before trying any home-based treatment.

Drink water

Water is an essential component of our body that counts about 60 percent of the total body. It contains essential vitamins like thiamin, biotin, niacin, and pantothenic acid necessary for the growth of organs like hair and nail(Almohanna et al. 2019).

Inadequate intake of water can lead to dehydration and hair fall results. This alopecia results from the insufficient supply of essential vitamins in water to our hair.

The hairs become thin, dry, frizzy, and more prone to fall. Apart from this, the existing hairs become fragile. Still, it also makes one prone to develop baldness because a dehydrated body can’t allow your hair to grow.

So, yes, drinking water makes a difference in good hair health and hair growth. Drinking water can support vitamins in the body. It can lead to exceptional hair growth and prevent hair root weakness.

Lifestyle modifications

Some simple lifestyle modifications can go a long way in treating alopecia. Avoid all abusive haircare practices like:

• Pulling hair while brushing
• Wearing tight hairstyles like a ponytail or tight braids
• Damaging hair treatments like perms

Meditation

If stress is the cause, stress-relieving practices should be a crucial treatment modality. Hogan says, “My patients must ease stress if they can, especially if they’re experiencing stress-induced alopecia.

Practices like yoga and meditation are good for overall well-being. One can take a holistic approach to optimize one’s body and health for hair regrowth.

Exercise

Exercises like jogging and walking are also beneficial in reducing your stress levels.

Devices

Some easy-to-use devices are available for treatment at home. The commonest ones include micro-needling devices, laser combs, and caps. According to the American Academy of Dermatology, hair fall devices show promising results.

Alternative Treatments

Hair loss has a negative psychosocial impact. Patients tend to opt for complementary and alternative treatment modalities instead of just conventional ones.

While some show promising results, more research is required to prove the usefulness and effectiveness of alternative treatments as follows:

• Amino Acids
• Collagen
• Vitamin D
• Onion Juice
• Rosemary Oil
• Fenugreek
• Egg and Yoghurt
• Coconut oil
• Green Tea
• Amla
• Aloe Vera
• Onion Juice
• Avocado
• Apple Cider Vinegar
• Ginseng
• Probiotics
• Essential oils

These options are not as effective as medical treatment options.

As a dermatologist, I usually recommend my patients eat a healthy diet rich in anti-inflammatory agents and let it resolve naturally. If auto-resolution does not happen, I usually prescribe some topical steroids and immune suppressor ointments.

Apart from medicinal therapy, this is associated with stress, so it is essential to rule out the precipitating cause.

References:

Phillips TG, Slomiany WP, Allison R. alopecia: Common Causes and Treatment. Am Fam Physician [Internet]. 2017 Sep 15 [cited 2021 Apr 25];96(6). Available from: https://pubmed.ncbi.nlm.nih.gov/28925637/

York K, Meah N, Bhoyrul B, Sinclair R. A review of the treatment of male pattern alopecia. Expert Opin Pharmacother [Internet]. 2020 Apr [cited 2021 Apr 25];21(5). Available from: https://pubmed.ncbi.nlm.nih.gov/32066284/

Herbert Pratt, C., Lloyd E. King, Jr, Andrew G. Messenger, Angela M. Christiano, and John P. Sundberg. 2017. “Alopecia Areata.” Nature Reviews. Disease Primers 3 (March): 17011.

Hordinsky, M. K. 2015. “Current Treatments for Alopecia Areata.” The Journal of Investigative Dermatology. Symposium Proceedings / the Society for Investigative Dermatology, Inc. [and] European Society for Dermatological Research 17 (2). https://doi.org/10.1038/jidsymp.2015.41.

Lepe, Kenia, and Patrick M. Zito. 2020. “Alopecia Areata.” In StatPearls [Internet]. StatPearls Publishing.