AA is a unique type of auto-immune hair loss that occurs when the body’s immune system becomes ‘confused’ and starts to attack the hair follicles.
It affects both children and adults, and can occur very rapidly. AA classically produces circular patches of hair loss. It may start as a solitary patch, and evolve overtime to produce multiple patches. 5% of patients lose every hair on their body including their eyebrows, eyelashes and body hair.
AA is both embarrassing and extremely upsetting for many patients including men, women and children. Some studies have shown that suicide is more common in young males with this condition – proving that it is much more than simply a ‘cosmetic concern.’
Like many autoimmune diseases, there is no single cause of AA. It is referred to as complex polygenic disease, which means that it results from the interaction between multiple genes (inherited from both parents.) More than 15 different genes have been identified as important in AA to date. It is often associated with other autoimmune disorders such as thyroid disease, vitiligo, coeliac disease and type 1 diabetes.
Although genes play a significant role as the basis of AA, environmental triggers are likely to influence whether or not it manifests (appears.) For example, in some people, alopecia areata may be triggered by severe stress or infection. In other patients, no clear trigger is ever identified. There is no convincing evidence that dietary or lifestyle modification improves alopecia areata, or prevents relapse.
In some cases patients with alopecia areata may notice that they start to regrow hair without any treatment at all – so called ‘spontaneous’ regrowth. In other cases of AA, first-line treatment is that of corticosteroid (cortisone) injections into the scalp. Steroids suppress inflammation and stops the immune attack on the hair follicles, thereby promoting hair regrowth.
Although some patients respond to well to injections, for other patients who have widespread involvement, oral medications may be required to help suppress the immune system. These treatments include oral steroid tablets or other anti-inflammatory tablets. Unfortunately these treatments do not guarantee regrowth, and the risk of side effects must be careful weighed up against the potential for regrowth.
Luckily there is a great deal of research occurring in the field of alopecia areata, and newer oral treatments have proven to be quite effective. Of course, these treatments are not suitable for everyone, but if you suffer from severe alopecia areata, it is worth discussing your options with a specialist Dermatologist.
For many people affected by alopecia areata, a wig is the only option to camouflage the scalp. It is vitally important that patients are supported emotionally, through education and support groups.