About Alopecia Areata

WHAT IS ALOPECIA AREATA?
ALOPECIA means hair loss.

Alopecia Areata is a particular disease affecting hair growth in the scalp and elsewhere. The loss is the cause of great concern to those affected, since the hair is a most important part of our "body image".

Alopecia Totalis: Total head hair loss.

Alopecia Universalis: Total head and body hair loss.

WHO GETS ALOPECIA AREATA?
The condition can commence in children and is most common in teenagers and young adults. It can occur for the first time in old age also. Most studies show that males and females are equally affected.

IS IT INFECTIOUS?
No. There is no way in which a person with Alopecia can transmit the problem to anyone else, and it is not "caught" by using someone else's comb or towel.

IS ALOPECIA AREATA INHERITED?
Yes, it can be inherited. However, this condition can affect only one member of a family. As will be discussed later, some related conditions can appear in other family members, and occurrence of Alopecia in relatives would be possible but unlikely.

IS IT COMMON?
No figures are available to answer this question - but 1-2% of new patients seen by dermatologists have Alopecia Areata. It is perhaps best to say that it is "not uncommon".

HOW DOES IT START?
Usually a bare scalp patch is noticed by the patient - or by hairdressers or relatives. It is unusual for the lost hair to be seen on the comb or on washing the hair.

WHAT AREAS ARE AFFECTED?
The scalp is the usual area, but the beard in men, and eyelashes or eyebrows may be affected alone, or together with scalp hair loss. In the uncommon severe forms, body hair may be lost as well. The only other structures affected are the nails and people with severe Alopecia Areata may show dulled and ridged fingernails.

WHAT DOES IT LOOK LIKE?
The patches are smooth, with few remaining hairs in the centre. Round the edge of the patch some stub-like hairs can usually be seen (often called "exclamation mark" hairs, as they are thicker at the tip than at the scalp level).

CAN THE LOSS BE DIFFUSE?
Less commonly, some hair may be lost over wide areas, causing general thinning of the hair. This can cause "hair to turn white overnight" by selectively affecting dark hairs and leaving grey hairs.

WHAT CONDITION CAN LOOK SIMILAR?
In children, tinea (ringworm) can produce hairless patches, but usually the hairs are broken and not lost, and the area is inflamed. The condition, which most closely resembles Alopecia Areata, occurs with the habit of "hair pulling" when this is confined to one area and is severe. Scalp diseases with scarring or diffuse hair loss due to other causes are significantly different from Alopecia Areata.

HOW IS IT DIAGNOSED?
The diagnosis is made by the story told of loss and seeing the typical patch of bare skin. It is very rare for tests to be needed to make the diagnosis.

WHAT TESTS MAY BE PERFORMED?
Hair can be plucked and examined under the microscope and if tinea is suspected, hairs may be taken for culture. For very careful study, a small biopsy may be performed for microscopic examination of the scalp skin.

In most cases, tests are performed only if there is a need to assess general health. Blood tests do not show any abnormality in Alopecia Areata.

WHAT CAUSES ALOPECIA AREATA?
The mechanism is known - inflammation develops around the hair roots and the hair roots become inactive and shrink in size. However, the cause of this inflammation is not understood. It is safe to say that no simple explanation such as deficiency of vitamins or other food, methods of hair care or external injury can be given. The cause is not any fungal bacterial or viral infection and it cannot be transmitted to any other person. It is likely that eventually the condition will be found to be "auto-immune", with another body tissue attacking the hair roots.

DO NERVES CAUSE ALOPECIA?
A severe shock can definitely set off an attack, but there is much less certainty that ordinary stresses of life affect the condition.

Of course, the person often becomes more tense and nervous through worrying about the hair problem itself.

WHAT CONDITION CAN ACCOMPANY ALOPECIA?
In children, Alopecia Areata may occur more often, or more severely if the child has eczema. In adults it is known that the patient or relatives are slightly more likely to show other auto-immune conditions than is the general population. These include colour loss (vitiligo) and thyroid disorders.

DOES ALOPECIA AREATA AFFECT GENERAL HEALTH?
No. All aspects of general health are unaffected- apart from the rare associations with other diseases. Young people who are affected are usually otherwise healthy.

WHAT HAPPENS AFTER ALOPECIA DEVELOPS?
It is thought that the majority of cases settle down and regrow after one or more patches have been present for some months.
However, sometimes the condition persists and new patches can appear while old patches regrow.
In the worst cases, the condition progresses (gradually or quickly) until large areas of hair have been lost. These cases naturally bring most distress to the people affected.
When the condition first appears, it is not possible to predict whether it will be mild and recover soon or will become severe.

IS IT KNOWN WHY SOME CASES BECOME SEVERE?
Apart from the uncommon type, which is accompanied by eczema in children, no information is available about this. Everyone hopes that early treatment will stop the progress of the condition, but if the alopecia is destined to be severe, this course may still be followed despite treatment.

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