Alopecia Areata

 Alopecia Areata (AA) is an autoimmune disorder (your immune system attacks the healthy cells in your body) that causes hair loss. "Alopecia" means baldness, and "area" means patchy hair loss. It is a chronic (long-lasting) inflammatory disease that targets the hair follicles, damaging them. Even though, in many cases, hair loss can be extensive and unpredictable, it is not a contagious disease. AA affects people of all ages but commonly affects adolescents or young adults. Although it is not a very serious disease, it may cause anxiety among affected people. 

To understand the types, causes, risk factors, symptoms, diagnosis, and treatment for alopecia areata, read on!

What Are the Types of Alopecia Areata?

There are four main types of alopecia areata depending on the amount of hair loss. 

• Alopecia Universalis: This type of AA exhibits loss of all your hair on the scalp and the entire body. 
• Alopecia Totalis: It is a chronic (long-lasting) condition of complete hair loss of the scalp. 
• Diffuse Alopecia Areata: It is a type of AA where the hair loss is scattered and widespread. 
• Ophiasis Alopecia: Hair loss follows a band along the sides and lower back of the scalp.

 What Causes Alopecia Areata?

In alopecia areata, your body's immune system attacks the hair follicles and disturbs normal hair formation for unknown reasons. This leads to abnormal hair loss, which may or may not regrow. 

Certain risk factors may increase your likelihood of developing alopecia areata. These include: 

• Genetic predisposition 
• Emotional stress
• Asthma (a disease in which the airway passages in the lungs become narrow. This causes cough, wheezing, and shortness of breath)
• Down syndrome (a genetic disorder causing developmental and intellectual delays)
• Pernicious anemia (disease in which the red blood cells are reduced due to deficiency of Vitamin B12)
• Seasonal allergies (hay fever, causing itchy, watery eyes and sneezing)
• Thyroid disease (a disease in which there is abnormal functioning of the thyroid gland and hormone production)
• Vitiligo (disease that causes loss of skin color in patches)

What Are the Symptoms of Alopecia Areata?

Common symptoms of alopecia areata include:

Hair Loss

• Hair usually falls out in round or oval patches on the scalp, leaving behind coin-sized bald areas.
• Patchy hair loss in your scalp, face, eyebrows, eyelashes, and body.
• Exclamation Mark Hair"- These are often short hair around the patches that are narrower at the base than the tip.
• "Cadaver Hair" - This is where hair breaks before reaching the skin surface.
• Sometimes, you may experience tingling, burning, or itching sensation on patches of the skin right before the hair begins to fall out.

Nail Changes 

• Nail pitting with disfigurement 
• Nails become rough and lose their shine
• White spots or lines may appear on the nails
• Both the toenails and fingernails are affected 

How is Alopecia Areata Diagnosed?

Alopecia Areata is usually diagnosed by your dermatologist (a doctor specializing in diagnosing and treating conditions related to your skin, hair, and nails) through your symptoms and medical history. 

However, the following additional tests may help in confirming the diagnosis:

• Hair Pull Test

Your dermatologist will grasp 40-60 closely grouped hair and apply a gentle grip. If more than 10% of hair is easily pulled out, then this test is considered positive 

• Trichoscopy

This test involves an examination of the hair follicle, hair shaft, and scalp with a dermatoscope (a device used to examine the skin structures that are not visible through the naked eye). 

The presence of yellow dots, small exclamation mark hair, and black dots (destroyed hair in the hair follicle opening) indicate alopecia areata. 

• Skin Biopsy

This test involves removing a small piece of skin from the scalp and studying it under a microscope. 

• Blood Tests

Blood tests are usually done to rule out other autoimmune disorders. 

How is Alopecia Areata Treated?

There is no cure for alopecia areata yet, but treatment helps focus on reducing symptoms, slowing down further hair loss, or helping the hair to grow back. 

Treatment options include: 

Medical Treatment

Topical Agents

These medications are rubbed against the scalp to stimulate hair growth. These include:

• Minoxidil
• Anthralin
• Topical steroids in the form of creams, foams, lotions, and ointments
• Topical immunotherapy drugs to spark off an allergic reaction to stimulate hair growth 

Injectables 

These are solutions or medications injected near the areas of hair loss to stimulate hair growth. These include:

• Steroid injections
• Intralesional corticosteroids

Oral Medicines 

These are consumed as per the dose prescribed by the dermatologists. These include:

• Oral steroids
• Oral immunosuppressants like cyclosporine

Laser Therapy

This therapy, also known as photochemotherapy, uses specific UV light wavelengths. Laser treatment delivers a specific radiation dose that encourages new hair growth by stimulating the hair follicles.

Natural/Conservative Treatment 

These treatments are all experimental and lack scientific evidence for their effectiveness. Consult your dermatologist before considering them. 

Natural Treatments

• Acupuncture
• Aromatherapy
• Vitamins, and supplements (zinc, biotin)
• Essential oils (coconut, castor, tea tree oils). These should not be taken without the advice of your dermatologist.

Anti-inflammatory Diet (Immune Protocol)

Eating this diet reduces the body's immune response and further hair loss by decreasing inflammation. Blueberries, nuts, seeds, lean meat, beans, and broccoli are some examples. 

Hair Accessories

• A wig or a hairpiece can cover up lost hair right away. This is used especially when hair loss lowers your self-esteem, causing anxiety or depression.
• “Vacuum wig" is a new technology made with silicon and a suction base. This helps you to swim with your wigs still in place.

Reduce stress

You can reduce stress with the help of meditation, yoga, adequate sleep, relaxing by listening to music, connecting with other people, following a healthy lifestyle, and exercising. 

Stick-on Eyebrows

Filling in eyebrows with makeup or a tattoo 

Summary

Hair loss can be alarming and daunting. Alopecia Areata is a common autoimmune condition characterized by hair loss anywhere on your body, but more specifically, affecting your scalp. Moderate hair loss is common and considered a natural physiological hair growth process. But with alopecia areata, you may notice more hair loss than usual. This may cause an array of hair and nail changes that can lead to stress, anxiety, and depression. Reach out to your dermatologist as soon as you notice hair loss. Also, follow a healthy hair routine and avoid hair products with harmful toxins and chemicals that may damage them and further deteriorate alopecia areata.