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What is Alopecia Areata?

What is Alopecia Areata?

Alopecia Areata is a common autoimmune disorder causing non-life-threatening but emotionally distressing patchy hair loss, which can progress to complete scalp hair loss (Totalis) or total body hair loss (Universalis). The condition occurs when the immune system mistakenly attacks hair follicles, forcing them prematurely into the resting phase without destroying the follicle itself, meaning regrowth is often possible. Treatment focuses on controlling this immune response and inflammation using options like corticosteroids, Minoxidil, or phototherapy, although success rates vary depending on the type and severity.

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Alopecia Areata is a form of autoimmune hair loss.
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Going through hair loss and balding at any age is distressing. Alopecia Areata is one of the most common causes of hair loss globally. While not life-threatening, this frustrating autoimmune condition is responsible for significant loss of self-esteem and emotional well-being. This blog delves into the causes, symptoms, and latest treatment options of Alopecia Areata, offering guidance and support to the millions of people affected by it worldwide.

Who Gets Alopecia Areata?

Alopecia Areata is a form of autoimmune hair loss. It causes spot or disc-shaped areas of hair loss, particularly on the scalp. An autoimmune disease triggers the body’s immune response against its cells and tissues, leading to inflammation and damage.

Alopecia areata is a common cause of hair loss worldwide, trailing after male and female pattern baldness. Although it can affect anyone and at any age, hair fall from alopecia areata is most frequently seen in:

  • Children

  • Individuals with a positive family history of alopecia areata

  • Individuals with a family history of autoimmune disease (Hashimoto's thyroiditis, Lupus, etc.)

  • People with a genetic predisposition for alopecia areata

  • Stress, anxiety, or trauma (possible triggers)

Types of Alopecia Areata

There are several types of alopecia areata:

  • Alopecia Areata Totalis: As the name suggests, this type of hair loss from alopecia areata affects the scalp and leads to complete hair loss. The hair may grow back, but the possibility is less than in other forms of alopecia areata.

  • Patchy Alopecia Areata: The hair fall in this type of alopecia is patchy. The patches are usually small and round. It is highly likely for hair to regrow. However, new areas of hair loss may eventually appear.

  • Alopecia Areata Universalis: This is the most severe and least common type of alopecia areata. It leads to hair loss all over the body.

  • Diffuse Alopecia Areata: Diffuse alopecia presents with hair thinning rather than frank hair loss.

  • Ophiasis Alopecia Areata: There is a distinct pattern of hair fall in Ophiasis. The hair on the temples and a band of hair along the back of the head (occipital region) is lost.

How Common is Alopecia Areata?

Hair loss from alopecia areata is fairly common worldwide. It affects both genders equally as well as children. The prevalence of this autoimmune disease is only second to pattern baldness as a cause of hair loss globally. There is no specific age of onset for alopecia areata; however, most cases of hair loss due to it present before the age of 30.

Alopecia areata does not discriminate based on age, gender, ethnicity, or location. Its presentation may vary from person to person. The symptoms may come and go, adding to the anxiety and stress of those who suffer from this frustrating disease.

What Happens if You Have Alopecia Areata?

If you have alopecia areata, your immune system is mistakenly targeting your hair follicles. Depending on the type of alopecia areata, the pattern of hair loss may vary between total, diffuse, localized, or patchy.

Pathophysiology

There are three steps to the pathophysiology of alopecia areata:

  1. Triggering of the Immune System: The immune system mistakenly identifies the hair follicles as “foreign”, triggering an inflammatory response.

  2. Disruption of Hair Follicles: The immune cells surround the base of the follicles and release pro-inflammatory chemicals (cytokines), which disrupt the growth phase (Anagen) of the hair follicles.

  3. Interruption of Growth: The hair follicles enter the resting or telogen phase suddenly and eventually fall off. The important point is that the follicle is not destroyed. Regrowth may be possible if the inflammatory reaction is treated or controlled.

Alopecia areata hair fall is not life-threatening. However, it has a significant impact on a person’s confidence, self-esteem, and social interactions, leading to stress and depression. The condition also varies between individuals, with some only getting one episode of hair loss, while others having recurrent flare-ups. The good news is that most forms respond well to alopecia areata treatment and regrowth is a definite possibility.

What are the Symptoms of Alopecia Areata?

The main symptom of alopecia areata is hair loss. The pattern of this hair loss may differ based on the specific type of alopecia areata. Hair fall of alopecia areata may target any hair-bearing part of the body, including the eyebrows, eyelashes, armpits, etc. People who have alopecia areata may have nail pitting, brittleness, and ridges as well.

Rarely, the patches of hair loss in alopecia areata may be associated with white hair growth, itching, follicular ostia, dot-like visible hair shafts, tingling or burning sensation, etc. Although regrowth is possible in mild cases of alopecia areata, the new hair follicles may be fine, completely white, or have patchy pigmentation.

What Causes Alopecia Areata?

Alopecia areata is an autoimmune disease. The exact cause for it is not known. However, some triggers may initiate an attack of alopecia areata. These include:

  • Emotional trauma (stress, anxiety, depression, PTSD)

  • Physical trauma

  • Illness and infections (Viral, bacterial)

  • Certain vaccines

  • Hormonal fluctuations (puberty, menstruation, pregnancy, menopause)

  • Toxins, allergens

  • Susceptible genetics

  • Scalp injury

How is Alopecia Areata Diagnosed and Treated?

There is no single investigation (blood test or scan) that can definitively make a diagnosis of alopecia areata. It is diagnosed by evaluating the patient based on a detailed history, physical examination, relevant tests, and lab analysis. After history and examination, the healthcare provider will do an in-depth examination of the sites of hair loss due to alopecia areata. This examination may include:

  • Looking for infections and allergies

  • Taking hair samples for lab evaluation

  • Scalp biopsy

  • Blood tests (Complete Blood Count)

Unfortunately, alopecia areata won’t resolve on its own and is not curable. Alopecia areata treatment manages the extent of hair loss, aims to decrease inflammation, and promotes regrowth. Alopecia totalis and universalis are less likely to improve and respond to treatment.

The treatment options include Corticosteroids, Minoxidil, Phototherapy, platelet-rich plasma Therapy, and topical immunotherapy. Alopecia areata responds poorly to treatment in children, individuals suffering from other autoimmune disorders, and those who have experienced prolonged periods without hair regrowth.

Frequently Asked Question

Seeking treatment early and using a combination of medication, diet, and suitable lifestyle modifications is the fastest way to recover from alopecia areata.

Newer treatments are targeting the immune response that causes hair fall in alopecia areata (JAK inhibitors).

Wash alopecia hair with a sulfate-free and mild shampoo. Avoid excessive scrubbing of the scalp while washing or drying the hair.

You can manage your alopecia areata by consulting a trained dermatologist and starting a suitable treatment plan.