Alopecia Areata
Alopecia Areata is an autoimmune skin disease that causes the body's
immune system to attack the hair follicles, causing baldness in
patches. It affects 1.7 percent of the population, including 4.7
million people in the United States.
Alopecia areata is thought to be an autoimmune disease that makes
the body to treat its hair follicles as foreign tissue and suppress
or stop hair growth. It is not contagious but may be hereditary
- there are a few recorded cases of babies being born with congenital
alopecia areata. Stress has not been proven to be a crucial factor.
Alopecia areata monolocularis describes baldness in only one spot,
alopecia areata multilocularis refers to multiple areas of hair
loss. In cases where the disease progresses to the point where all
scalp hair is lost, it is called Alopecia Totalis, and where hair
loss advances to the entire body it is called Alopecia Universialis.
The disease may also be limited only to the beard (alopecia areata
barbae).
Hair loss with alopecia areata comes in stages, with hair returning
and falling out in phases.
First symptoms are small, soft, bald patches which can take just
about any shape but are most usually round. Initial presentation
most commonly occurs in the late teenage years but can happen with
people of all ages. It most often affects the scalp but may occur
on any hair-bearing part of the body. There may be different skin
areas with hair loss and regrowth in the same body at the same time.
It may go into remission for a time or permanently. The longer the
hair loss persists, the smaller the chance that it will grow back.
Fingernails may be affected, especially in severe cases where various
nail changes may appear, the most common of which would be pitting
of the fingernails.
Episodes of alopecia areata before puberty predispose to recurrent
episodes after puberty. Pitting of the fingernails can hint at a
more severe or prolonged course.
Effects of alopecia areata are mainly psychological (loss of self
image due to hair loss). However, patients also tend to have a slightly
higher incidence of asthma, allergies and atopic dermal ailments
and even hypothyroidism. Loss of hair also means that the scalp
burns more easily in the sun. Loss of nasal hair increases severity
of hay fever and similar allergic conditions. They may also have
aberrant nail formation because keratin forms both hair and nails.
There is no cure for alopecia areata. If the affected region is
small, it is reasonable to observe the progression of the illness
as the problem often spontaneously regresses and the hair grows
back. Initial stages may be kept from increasing by applying topical
corticosteroids. In cases where there is severe hair loss, there
has been limited success treating alopecia areata with steroids
(intradermal, topical or oral), other immune modulators, minoxidil
or phototherapy.
Hair implants may help covering bald spots, but cannot guarantee
satisfactory outcome, since the bald areas might expand. Wigs should
be prescribed if patients, especially female patients, mention social
discomfort.
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