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Alopecia Areata
What is alopecia areata?
Alopecia areata is
a common cause of hair loss. It usually causes patchy round areas of
baldness to appear on the scalp, although other hair-bearing skin may
be affected, including the beard, body, eyebrows and eyelashes.
What causes
alopecia areata?
It occurs because
the affected person's immune system does not recognise the hair
follicles as "self", but regards them as "foreign". The response
produced by the immune system causes the loss of hair. There is no
permanent damage to the affected hair follicle, and once the immune
system tolerates the follicle correctly, the hair can regrow. This
type of attack is called an "autoimmune" response.
People of all ages
and races can get alopecia areata. It often starts in childhood. It
can run in families. A person with alopecia areata is more likely than
the general population to have or to develop other autoimmune
conditions such as thyroid disease, diabetes and vitiligo (this
produces white patches on the skin), although the risk of getting
these disorders is still low. Alopecia areata is not catching.
Often we just do
not know what triggers an attack of alopecia areata. For some people
stress can play a part, particularly events such as bereavement,
separation and accidents. We know alopecia areata is not due to diet
or vitamin deficiencies.
Is alopecia
areata hereditary?
Around 1 in 5
sufferers have a close family member who also has alopecia areata.
What are the
symptoms?
Usually, there are
none. Sometimes, you may feel a tingling in your scalp in the affected
areas. Many of those who have alopecia areata are greatly upset by it,
particularly if it relapses.
What does
alopecia areata look like?
Hairdressers often
spot the condition first as a single patch or small number of patches
of hair loss on your scalp.
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At the edge of the
patch of hair loss, you can sometimes see short, tapered hairs called
"exclamation mark" hairs. These hairs are characteristic of alopecia
areata.
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The affected scalp
is usually not scaly or inflamed.
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Sometimes you will
see fine, pale or even white hairs regrowing in the centre of the
patch. These hairs thicken as time goes by and start to get their
colour back (pigmentation).
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Sometimes, people
with alopecia areata also develop tiny fine pits on the surface of
their nails - rather like those seen on a thimble. Otherwise no other
parts of the body are affected.
Can it be cured?
No, alopecia areata
cannot be cured. Treatments are available that may help your hair to
regrow; but, there is no treatment that will prevent alopecia
happening again.
If your hair loss
is patchy, there is a good chance (about 60-80%) that you will get
complete regrowth within 1 year without treatment. However, if you
have a very large amount of hair loss from the start, the chances of
it regrowing may not be as good as this. In people with Down's
syndrome, or those who have severe eczema, the chances of regrowth are
not so good either.
How can alopecia
areata be treated?
Many people with
mild early alopecia areata may need no treatment, as their hair is
likely to come back anyway without it. However some treatments can
induce hair growth, though none is able to alter the overall course of
the disease. Any treatments that carry serious risks should be
avoided, as alopecia areata itself has no direct impact on general
health.
Treatments used
for alopecia areata include the following:
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Steroid creams
and scalp applications. These are applied to the bald patches,
usually twice a day, and can help the hair to regrow more quickly.
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Local steroid
injections. These can be used on the scalp and brows, and are the
most effective approach for small patches of hair loss. Injections may
be given via a needle and syringe or with an air jet injector (this
may be less uncomfortable). After several weeks, a 0.5 cm diameter
tuft of hair will be seen at the injection site. Injections can be
repeated every few months. Special care is taken around the eyes, when
injecting the brows, as injecting too much may cause glaucoma (raised
pressure inside the eyeball). A small dimple may develop at sites of
injections, but this usually recovers without treatment after a few
months.
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Steroid tablets.
Large doses of steroid tablets given long term may cause the hair to
grow again, but there are significant risks to general health with
this treatment (including raised blood pressure, stomach ulcers, eye
lens cataracts and osteoporosis). In view of these dangers, it is
currently ‘not possible to support their use until there is better
evidence of efficacy’.
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Contact
sensitisation treatment. This involves initially applying a strong
sensitizer (usually a chemical called diphencyprone) to the skin of a
person with alopecia areata to make them allergic to it. Then weaker
strengths of the sensitizer are applied to the bald areas every week
to produce a mild allergic dermatitis. A worthwhile regrowth will
occur in up to 50% of sufferers in about 6 months. The treatment may
produce more severe local reactions. Loss of skin colour (depigmentation)
may develop, so it is used with caution in those with dark skin.
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Ultraviolet
light treatment. Using UVA radiation after taking psoralen
tablets, or applying a psoralen cream to the bald areas to sensitise
the skin, a treatment called PUVA, may be effective. Treatments are
needed twice weekly for a number of months. Relapse of the alopecia is
common when the treatment is stopped.
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Minoxidil
lotion. This substance, which is applied topically to the bald
areas, may help some sufferers although it seldom produces
cosmetically useful regrowth in people with extensive hair loss.
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Dithranol.
This is an irritant cream that is usually used to treat a skin
condition called psoriasis. It can be applied to the bald areas of
alopecia areata and may help the hair to regrow. To work, it needs to
be used often enough, and strong enough, to produce local skin
irritation. It is less effective than contact sensitisation, but safer
and easier to use. Dithranol will stain blonde or fair hair a purple
colour, precluding its use.
What if I need a
wig?
Some sufferers will prefer to wear a wig whilst they wait for recovery
from their alopecia. Wigs and partial hairpieces can be bought
privately or obtained through the NHS on a consultant's prescription.
Local dermatology departments can often recommend local suppliers who
are sensitive to the needs of alopecia areata sufferers. An acrylic
wig costs between £60 and £200, whilst human hair wigs are around ten
times as expensive and need more upkeep. Current NHS prescription
charges (2004 prices) are £50.70 for an acrylic and £195.40 for a
human hair wig. If you get free prescriptions (under 18, over 60 or on
income support), you will receive a prescription wig free of charge.
You will only qualify for a human hair wig on prescription if you are
allergic to acrylic wigs or you have a skin condition that means you
would need a human hair wig.
What can I do?
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You may find that
meeting other sufferers from alopecia areata, or joining a patient
support group (below), will make it easier for you to adjust to your
condition.
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Remember that the
main function of hair is to protect the top of the scalp from
sunlight. You should cover your bald patches to protect them from the
sun, either with a sun block or a hat. If you expose your bald patches
to the sun, they are likely to get sunburnt and you will increase your
chances of getting long-term sun damage.
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If you find that
the regrowing hair is slow to recolour, it can be dyed.
Where can I get
more information?
Patient Support Groups
National
Alopecia Areata Foundation - American web site with useful
links and advice about coping with alopecia.
http://www.naaf.org/
Hairline International - a patient's society: Lyons
Court, 1668 High Street, Knowle, Nr Solihull, West Midlands, B93 0LY
For thinning hair, a new range of products called Nisim are available
via the internet: see
www.hairloss-europe.com
‘liver’
spots
Do you have
‘liver’ spots? They are those flat, brown discolourations of the
skin, rather like joined-up or enlarged freckles. They have nothing to
do with the liver, as far as is known, and tend to appear in people in
their forties and fifties, possibly through exposure to sun, often
initially on the backs of hands. For some, they are seen as a
disfigurement, a sign of ageing. They are, however, quite harmless.
Can they be
removed? Laser treatments will remove the surface discolouration,
exposing clear skin underneath. The treatment can be targeted so that
the rest of the skin is not affected.
 Anything less
drastic? Facial peels may help. There are also bleaching creams
available. Nutrimetics advanced Anti-Age Spot & Pigmentation
Corrector is a new product specifically to help visibly reduce the
appearance of these spots and lighten skin for a more even appearance.
Nutrimetics Ultra Care+ Anti-Age Spot & Pigmentation Corrector 30ml
costs £18.50. For more information, to request a catalogue, or to purchase Nutrimetics
products, contact your local Nutrimetics Consultant using our
enquiry form.
You may wish to consult your doctor to make sure any brown spots
are in fact harmless.
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