Alopecia Areata

Alopecia areata

Introduction

Alopecia areata is a non-scarring form of hair loss that usually beings with round patch. It can involve any hair-bearing area of the body and is characterized histopathologically by peribulbar lymphocytic infiltrates. Cases of mild involvement show a marked tendency to spontaneous regrowth of hair. With the exception of androgenetic hair loss, alopecia areata is by far the most frequently occurring form of hair loss.

Etiology and associated diseases

The exact cause of this disorder is not known. It is thought to be caused by autoimmunity against our own hair follicles (roots). An association with other autoimmune disorders like vitiligo, pernicious anaemia, thyroid disorders has been reported.

Clinical features

A well defined patch of hair loss (usually coin shaped) develops on any part of the scalp. Grey hair may be seen growing from the patch. This patch may resolve on its own without any treatment. Sometimes, it starts increasing in size and new patches develop. This is called progressive alopecia and requires urgent intervention by a dermatologist.

Sometimes, it may spread to involve eyelashes, eyebrows and body hair.

When alopecia areata involves the hairline (front, sides or back), then that pattern is called ophiasic pattern.

Alopecia totalis is the term used to denote the loss of all scalp hair

Alopecia universalis is the term used to denote the loss of all body hair

Necessary therapeutic measures

Appropriate information on the course and prognosis of alopecia areata is needed. The patient should be informed that a spontaneous remission is always possible. In mild forms characterized by some round patches there is an 80% probability that spontaneous regrowth will occur within a period of 1 or 2 years. In cases of more extensive or total hair loss the prognosis is considerably less favourable, but a spontaneous regrowth of hair is never excluded.

Psoralen and ultraviolet A (PUVA) treatment

PUVA treatment with oral application of 8-methoxypsoralen can be categorized as effective but its practical applicability is rather limited because the UV light can no longer reach the scalp when hair is regrowing. The same is true for the ‘PUVA-turban’ treatment.

Local injections of corticosteroids

In exceptional cases of recalcitrant circumscribed bald patches, local injections of corticosteroids may be considered. However, in cases of more pronounced involvement this therapeutic approach is worthless.

Advice regarding prosthetic camouflage

In case of extensive or total alopecia areata the question of applying a wig should be discussed with the patient of applying a wig should be discussed with the patient. It is important to realize that wigs made of artificial hair appropriately fulfil the cosmetic requirements. Moreover, cleaning of a wig made of artificial hair is much easier. On the other hand, wigs made of genuine hair are more durable. For economic reasons it seems unjustified to demand that the health plan should take over the costs for wigs made of human hair for all patients with alopecia with alopecia areata.

Additional desirable measures

From a psychological point of view, it is important that the dermatologist shows commitment and offers the option of regular appointments. In this way the patient will not feel left alone with his problems, and he will learn to cope adequately with this disease which often tends to run a chronic course. In exceptional cases, however, the psychological support that can be given by a dermatologist may be insufficient, and in such cases the help of a specialized psychologist should be considered. It is important, however, that the physician and the patient himself both understand the aim of such psychological help. Such inter views cannot be offered with the aim to elucidate the ‘cause’ or ‘meaning’ of alopecia areata, or to induce regrowth of hair. Rather, the rationale of any psychosomatic approach is to offer support in coping with a cosmetically devastating disease. Dermatologists should be aware that many psychologists erroneously believe that their specialized knowledge and skills enable them to induce hair regrowth in alopecia areata. In reality, such psychosomatic approaches do not inhibit a spontaneous remission of alopecia areata.    

Dr Pradeep Sethi

Dr Arika Sethi

www.directhairtransplantation.com/