DermNote

What is alopecia areata?

Alopecia areata is a skin condition that typically causes round patches of hair loss, usually on the scalp. For unknown reasons, the body’s own immune system attacks the follicles that the hair grows from, and forces these hairs to shed.

The extent and duration of hair loss in alopecia areata is unpredictable. In many cases, the hair will return in a few months; however, many patients will experience recurrences. Alopecia areata can affect any age group, gender, or race, and it is more likely among people who have an affected family member. Most patients do not have any identifiable cause, but some cases may be precipitated by severe stress, pregnancy, infections, or medications. Alopecia areata can occur on its own, or may be associated with other autoimmune diseases such as thyroid disease or type I diabetes.

What are the symptoms of alopecia areata?

Alopecia areata most commonly presents as round or oval patches of hairless skin on the scalp that form over the course of a few weeks. Other areas, such as eyebrows, the beard, or body hair may also be affected. Some patients report an itching or burning sensation as well.

Alopecia areata can also affect the nails. The most common nail finding is little pits or depressions in the nails.

Due to the frequently visible nature of the hair loss, many patients may find themselves feeling depressed or anxious.

How is alopecia areata treated?

In many cases the hair will eventually grow back, with or without treatment.

The most common treatment is corticosteroids injected or applied as a cream or ointment at the site of hair loss. Corticosteroids weaken the immune system at the site, giving the hair follicles a chance to recover without immune attack.

Other treatments include a topical irritant called anthralin or topical minoxidil.

Another form of treatment is topical immunotherapy. Your doctor will first apply a substance such as squaric acid or diphenylcyclopropenone to an unaffected area of skin to cause an allergic reaction. This substance is then applied to the area of hair loss.

Patients with severe disease that does not respond to treatments applied over the area of hair loss may need systemic immune system suppressants such as oral glucocorticoids or cyclosporine.

Cosmetic solutions such as wigs, false eyelashes, and temporarily tattooed eyebrows should also be considered. Some patients may prefer to completely shave the affected areas to minimize the visibility of the bald patches.

What can I expect from the treatment?

It usually takes several months for hair to return, and you may need to follow your prescribed treatment for the entire time. Hair loss can recur after therapy.

When should I be concerned and contact my physician?

Contact your doctor if you observe changes in your nails or your vision; if you are feeling chronically fatigued, irritable, or nervous; or if you experience unexplained changes in your weight.

If you are on an immune-suppressing medication, contact your doctor at any sign of an infection or illness, such as fever, chills, or cough.

Contact your doctor if you are feeling anxious or depressed about your hair loss. Your health care provider can help you find the support you need.