What is it?
Alopecia areata (AA) means loss of hair or complete baldness. It is characterised by rapid and complete loss of hair in one or more round or oval patches usually on the scalp, bearded area, eyebrows, eye lashes, and less commonly on other hairy areas of the body. Often the patches are from 1-5 cm in diameter. A few resting hairs may be found within the patches. White hairs are rarely affected. Sudden whitening of hair may represent wide spread AA in a patient with salt pepper hair.
Of approximately 1 in 5 people the nails develop uniform pits or ridges. Apart from the bald patch or patches the bare skin is normal and healthy and there is no scarring. In some cases hair will regrow within several months and in other cases the hair loss is permanent with no signs of regrowth.
Naturally, some people show signs of depression, social isolation or become anxious due to their change in appearance.
AA is higher in incidence when linked with atopic dermatitis, down-syndrome, lichen planus, thyroiditis, and auto immune diseases such as systemic lupus erythematosous, diabetes mellitus, myasthenia gravis, vitiligo. Nevertheless, most cases of AA occur without associated disease.
What causes it?
It could be an autoimmune (AI) disease whereby the body produces antibodies which normally would attack foreign bodies but in AI disease these antibodies mistakenly attack the body’s own cells. It is thought that in AA the antibodies attack the cells concerned with hair follicles and this causes inflammation which leads to loss of hair from the hair follicles. Interestingly the hair follicles are not destroyed and thus have a capability of producing hair.
Other triggers considered include viruses, infections, medicines or other environmental factors. There is also an inherited factor which makes people more prone to autoimmune disease. About 1 in 4 people with AA have a close relative who is also affected.
How is it diagnosed?
This is done by simple clinical examination of the patches. If the doctor is in any doubt then a small sample of the skin from the bald patch can be sent away for examination to rule out other causes of baldness.
What is the treatment?
As the course of the disease is unpredictable it could be that it improves on its own. If treatment is deemed necessary the following are possibilities.
For patchy AA the following treatments may be used: topical or intra lesional corticosteroids, topical monoxidal 2 or 5% , anthralin, and combination therapy. The treatment of extensive AA may include the use of topical immunotherapy , psoralen plus ultra violet A light (PUVA), systemic prednisone and pulse methyl prednisolone.
Generally, the success rate for the various treatments is probably not high. Also, there is no guarantee that any hair re-grown during treatment will persist once the treatment is finished. Other option is to wear a wig.
The prevalence of skin disease exceeds that of obesity, hypertension, or cancer. Despite skin being the largest organ of the human body, dermatological research remains one of the most under funded areas of medicine. In a world where society has an increasing preoccupation with image and it’s importance to every aspect of a person’s life, sufferers of skin diseases are feeling and being more marginalised and isolated than ever.
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