Understanding Alopecia Areata

Author: FITivate | Published date: November 8, 2021 | Category: Medical
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Alopecia areata, otherwise known as autoimmune alopecia. The body of these patients produce immune cells that actually causes destruction of hair follicles.The exact mechanism is not yet fully understood.

Characteristics of Alopecia areata

Clinically, the bald patch will look pinkish and smooth with very fine thin hair surrounding it.

If you examine the fine hair surrounding the patch of hair loss with a dermatoscope or magnifier - you may see “exclamation mark” shaped hair where there is thinning of the stalk of the hair near to the follicle.

This hair loss disease may affect any part of our body with hair. The most common areas include the scalp and the eyebrow. Most cases are mild, where you see only less than 5 spots on the scalp.

However, in severe cases you may have :

Alopecia totalis

Where nearly all the hair on the scalp is lost ( this is seen in about 5% of the cases )

Alopecia universalis

Where all the hair on the entire body is lost. Fortunately this occurs in less than 1% of the cases.

Occasionally, it can involve the nails as well

Some patients may exhibit

  • pitting
  • ridging
  • separation of nail from nail bed, known as onycholysis

The diagnosis of alopecia areata is usually a clinical one made by the doctor’s examination.

Risk factors of getting Alopecia areata

Technically it can happen to anyone or everyone with a lifetime risk of about 1-2%. However your chance of getting it is higher if

  1. There is a positive family history. About 10-25% of patient has a family history of Alopecia areata.
  2. If you have other autoimmune diseases like Celiac disease, Thyroid disorders, Vitiligo or Rheumatoid arthritis.
  3. or if you have allergic conditions like Atopic Eczema or Allergic Rhinitis.

We do know also that there are triggering factors that can provoke the onset of the hair loss like

  • emotional or physical stress
  • hormonal changes
  • trauma
  • viral infection

Is Alopecia areata treatable?

The milder cases of Alopecia areata tend to recover on their own. It may take months to years before the hair on the bald patch gradually grow back again.

There are some ways to accelerate the hair regrowth.

Options include

  1. Topical minoxidil like minoxidil spray
  2. Steroid treatment, either injection into the bald patch or topical application of steroid lotions.

In severe cases like Alopecia totalis, application of immunotherapeutic agents on the affected area may be helpful.

Systemic treatment with oral or intravenous medications may be reserved only for patients with rapid and chronic hair loss that involves large areas of the body. Oral steroids or even oral biologics have been explored.

Is Alopecia areata recurrent?

Recurrence rate for alopecia areata is very high - as high as 50%. In some cases, the hair loss maybe permanent.

Avoidance of stress may be helpful in reducing the recurrences.

When all else fails, artificial hair such as wigs or hair pieces can be used to provide coverage for the scalp. Artificial eyelashes or eyebrows or innovative cosmetics and tattoo can be used to improve the appearance.

Read Also : Male pattern baldness

By : Dr Chen Yiming

Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)



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