Although not too many have heard about it- the fact is that Alopecia areata is a very common and specific autoimmune disease, in which the immune system, normally designed to protect the body from foreign invaders, now attacks its own tissue, the hair follicles- in this case. Hair follicles are those tiny cup-shaped structures from which our hairs grow. Of course- the result is- hair loss on the scalp and elsewhere. Unlike other types of Alopecia, in this case- hair falls out in small, round patches about the size of a quarter. It is also a fact that the clinical picture can also vary in different people because, some experience really extensive hair loss. Good thing is that disease rarely causes some serious health problems, although it can progress to total loss of hair on the head - alopecia areata totalis or complete loss of hair on the head, face, and body %26ndash; condition called alopecia areata universalis.Alopecia areata is sometimes called spot baldness.
Alopecia types
- Alopecia areata monolocularis
It is important to point out that this type is characterized by baldness in only one spot which may occur anywhere on the head.
- Alopecia areata multilocularis
Unlike the previous type- this type refers to multiple areas of hair loss which can sometimes cover up the whole body!
- Alopecia areata totalis
This is the uncommon type but it is important to know that, if the patient loses all the hair on scalp, the disease is then called Alopecia areata totalis.
- Alopecia areata universalis
This is the most expressed type of this disease and it is characterized by all body hair loss, including pubic hair.
- Alopecia areata barbae
The fact is that the disease may also be limited only to the beard and in this case- it is called Alopecia areata barbae.
- Diffuse alopecia areata
Almost everyone have heard about some case where patient's hair to appear to have turned white overnight.
This is called diffuse alopecia areata and, in most cases, it happens due to the psychological trauma.
This is called diffuse alopecia areata and, in most cases, it happens due to the psychological trauma.
Possible causes of alopecia areata
- Autoimmunity
Everyone should know that there are many evidences that support the hypothesis that Alopecia Areata is an autoimmune condition. How come? Well, most of the scientists believe that the process is T-cell mediated but antibodies directed to hair follicle structures also have been found in patients also directs to the B-cell response.
If we talk about histological structure %26ndash;then we should know that lesional biopsies show a perifollicular lymphocytic infiltrate which is mostly made out of T-helper cells and T-suppressor cells.
- Genetics
If we talk about possible cause of Alopecia Areata, then we should know that many scientists favor a genetic predisposition for disease. It isn%26rsquo;t hard to understand this because the frequency of positive family history for Alopecia Areata in affected patients has been estimated to be 10-20% compared to 1.7% in control subjects. This is pretty secure sign! Are there any other proofs! Well, two recent studies demonstrated that human leukocyte antigen DQ3 was found in more than 80% of patients with Alopecia which suggests that it can be a marker for general susceptibility to this condition. So, the right conclusion would be that genetic factors are likely to play an important role in determining susceptibility severity of this disease.
- Cytokines
Substances called cytokines among which the most famous -Interleukin 1 and tumor necrosis factor were shown to be potent inhibitors of hair growth. Microscopic examination of hair follicles showed increased concentration of these substances.
- Innervation and vascularisation
Everyone should also know that another very important area of interest is the modification of perifollicular nerves-nerves that surround the follicle. The scientist came to this conclusion because of the fact that patients with this condition occasionally complain of itching or pain on affected areas.
It could also have a lot with the local circulation and some specific blood factors! It is proven that circulating levels of the neuropeptide calcitonin gene-related peptide were decreased in 3 patients with AA compared to control subjects. This peptide has multiple effects on the immune system, including chemotaxis and inhibition of Langerhans cell antigen presentation and inhibition of T-lymphocyte proliferation. CGRP also increases vasodilatation and endothelial proliferation.
- Viral etiology
Patients should know that none of these hypothesis or facts is final and that many other hypotheses have been proposed but more evidence is needed to support them. Scientists also believe that the disease could possibly have an infectious origin, but no microbial agent has been isolated consistently in patients.
Symptoms of Alopecia Areata
Although symptoms can vary- there are some common symptoms which are characteristic to this condition. Some of the most commons are:
- Hair loss, which is most often is localized and patchy
- Experts are saying that hair loss on other hair-bearing areas also favors the diagnosis.
- Scientists claim that the most common presentation is the appearance of 1 or many round-to-oval denuded patches.
- No epidermal changes are associated with the hair loss.
- Alopecia Universalis occurs with complete loss of hair on all body areas with hear on it
- Alopecia Totalis occurs with 100% hair loss on the scalp
- Nail involvement is also very common characteristic and in most cases it includes:
- Pitting
- Several other: trachyonychia, Beau lines, onychorrhexis, onychomadesis, koilonychia, leukonychia, red lunulae
Diagnosis of Alopecia Areata
- Bald patches
Every patient should know that in most cases the first symptoms are small, soft, bald patches. Although they can have almost any shape %26ndash;they are most usually round. If we talk about common age of onset Initial presentation most commonly occurs in the late teenage years but can happen with people of all ages. Every patient should also know that it also may go into remission for a time, or permanently. There is one rule- the longer the hair loss persists, the smaller the chance that it will grow back.
- Exclamation point hairs
Important thing to point out is that another very common presentation of the condition is exclamation point hairs. What exactly are these points? Well, exclamation point hairs are hairs that become narrower along the length of the strand closer to the base. Therefore, they are producing a characteristic exclamation point appearance which is very easy to recognize.
- Hair pulling
Although it may seem brutal, hair pulling is one very good diagnostic tool. This technique is always applied by medical professionals and it is based on gently pulling at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair. The fact is that, when we talk about a healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp. Every patient should know that in cases of Alopecia, hair will tend to pull out easy along the edge of the patch where the follicles are already being attacked by the body's immune system.
Therapy of Alopecia Areata
Unfortunately- there is no definite cure for Alopecia areata! But, the fact is that while there is neither a cure for alopecia areata, some patients find that some specific medications approved for other purposes can help hair grow back. But, nothing represents a definite solution!
- Corticosteroids
Almost everyone has heard about these famous medications! The fact is that corticosteroids are powerful anti-inflammatory drugs which suppress the immune system if given orally. It is important to know that corticosteroids may be administered in three ways:
%26middot; Local injections
It is very important to know that injections of steroids can be administrated directly into hairless patches on the scalp and sometimes the brow and beard areas are effective in increasing hair growth in most people. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects. What are the common side effects which could occur from using these medications? Well, the main side effects of injections are pain, mild swelling, and changes in pigmentation, as well as small indentations in the skin.
%26middot; Oral corticosteroids
Every patient should know that the corticosteroids taken by mouth are the mostly used type of treatment for many autoimmune diseases. But it is also important that, because of the risk of side effects, such as hypertension and cataracts, they are used only occasionally for alopecia areata.
%26middot; Topical ointments
Everyone knows that creams rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. These creams or ointments contain all needed steroids and could be extremely helpful!
- Minoxidil (5%)
Several researches done in the past have shown thattopical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing. Good thing is that this Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata.
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