Alopecia areata is a common autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis).

Alopecia areata affects approximately two percent of the population overall, including more than 4.7 million people in the United States alone. This common skin disease is highly unpredictable and cyclical. Hair can grow back in or fall out again at any time, and the disease course is different for each person.

Types of Alopecia Areata

Alopecia areata is a common disease that results in the loss of hair on the scalp and elsewhere on the body. There are three types of alopecia areata; alopecia areata, alopecia areata totalis and alopecia areata universalis.

In all forms of alopecia areata, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years.

Alopecia Areata - The most common variation of the autoimmune disease, presents itself as round, smooth patches of various sizes.

Alopecia Areata Totalis - Alopecia areata totalis presents itself as total loss of hair on the scalp.

Alopecia Areata Universalis - Alopecia areata universalis is the rarest form of alopecia areata and presents itself as the loss of hair over the entire scalp and body.

Autoimmunity and Alopecia Areata

Because affected hair follicles are mistakenly attacked by a person’s own immune system (white blood cells), resulting in the arrest of the hair growth stage, alopecia areata has been characterized as an autoimmune disease.

The following articles may be of interest if you would like to learn more about the alopecia areata/autoimmune connection.

Johns Hopkins Medical Institution

MD Anderson Cancer Center

American Academy of Dermatology

American Osteopathic College of Dermatology

Alopecia Areata in Children

Alopecia areata is a common condition that occurs in males and females of all ages, buy young persons are affected most often. The alopecia areata experience varies with age and can be especially difficult, for the patient as well as the parent, when it presents itself during childhood. The National Alopecia Areata Foundation has many programs created to ease the burden of the entire family when a child is diagnosed with alopecia areata.

Children under the age of five

Children under the age of five react very little to their alopecia areata, having very little impact if any. The preschool child is so busy exploring their world, acquiring skills and gaining independence, that his appearance is insignificant to himself and his peers. His hairloss may be an interesting anomaly, and nothing more; most likely his peers will not take much notice to this difference.

Children ages six through twelve

Between the ages of six and twelve, children have gained experience and interacted with enough people to grasp the idea that views of the world differ, and that it is important to pay attention to what others think and feel. While this ability to see things as others do helps children become more empathetic and considerate, it also tends to make children more self-conscious. Children at this stage of development are much more concerned about how others view them, how they may differ from others, and whether others might be making fun of them. Since children at this age have become so aware of individual differences, they unfortunately are more likely to poke fun at those who don’t’ fit their definition of ‘normal’.

Even if a child has had alopecia areata since infancy, he now faces new problems of adjustment. Peers are becoming a more significant part of his life and the desire to ‘fit in’ is becoming stronger. Even a child with a very healthy self-concept may feel threatened. However if a child feels good about herself and has at least one skill she enjoys and is passionate about, the odds are increased that she will deal successfully with these difficulties.

Treatment for Alopecia Areata

In all forms of alopecia areata, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years.

There are no FDA approved treatments specifically for alopecia areata, alopecia areatatotalis or alopecia areatauniversalis, however many medical professionals are willing to try treatments off label.

Mild, Patchy Alopecia Areata

There are treatment options available for mild, patchy alopecia areata (less than 50% scalp hair loss) though there is currently no acceptable treatment that works in all cases.

Cortisone injections: The most common treatment is the injection of cortisone into the bare skin patches. The injections are usually given by a dermatologist who uses a tiny needle to give multiple injections into the skin in and around the bare patches. The injections are repeated once a month. Both the needle prick and the slight tingling are usually well tolerated and there is no discomfort after leaving the doctor’s office. If new hair growth occurs, it is usually visible within four weeks. Treatment, however, does not prevent new patches from developing. There are few side effects from local cortisone injections. Occasionally, temporary depressions in the skin result from the local injections, but these “dells” usually fill in by themselves.

Topical Minoxidil: Five percent topical minoxidil solution applied twice daily may regrow hair in alopecia areata. Scalp, eyebrows, and bear may respond. If scalp hair regrows completely, treatment can be stopped. Two percent topical minoxidil solution alone is not effective in alopecia areata; response may improve if cortisone cream is applied thirty minutes after the monoxidil. Topical minoxidil is safe, easy to use, and does not lower blood pressure in persons with normal blood pressure. Topical minoxidil solution is not effective in treating those with 100% scalp hair loss.

Anthralin cream or ointment: Another treatment is the application of anthralin cream or ointment. Anthralin is a synthetic, tar-like substance that has been used widely for psoriasis. Anthralin is applied to the bare patches once daily and washed off after a short time, usually thirty to sixty minutes later. If new hair growth occurs, it is seen in eight to twelve weeks. Anthralin can be irritating to the skin and can cause temporary, brownish discoloration f the treated skin. By using short treatment times, skin irritation and skin staining are reduced without decreasing effectiveness. Care must be taken not to get anthralin in the eyes. Hands must be washed after applying it.
 

Alopecia Areata Totalis and Alopecia Areata Universalis

Fewer treatment options are available for extensive alopecia areata (greater than 50% scalp hair loss).

Cortisone Pills: Cortisone pills are sometimes given for extensive scalp hair loss. Cortisone taken internally is much stronger than local injections of cortisone into the skin. It is necessary to discuss possible side effects of cortisone pills with your physician. Healthy young adults often tolerate cortisone pills with few side effects. In general, however, cortisone pills are used in relatively few patients with alopecia areata due to health risks from prolonged use. Also, regrown hair is likely to fall out when the cortisone pills are stopped.

Topical Immunotherapy: Another method of treating extensive alopecia areata or alopecia areatatotalis/universalis is known as topical immunotherapy and it involves producing and allergic rash or allergic contact dermatitis. Chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB), or squaric acid dibutyl ester (SADBE) are applied to the scalp to produce an allergic rash which resembles poison oak or ivy. Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment. Those who do successfully regrow scalp hair still need to continue the treatment to maintain the hair regrowth, at least until the condition turns itself off. An itchy rash may be uncomfortable in very hot weather, especially under a wig. These treatments are not available everywhere in the United States although they are used frequently in Canada and Europe.

Wigs: In general, treatments are much less effective for extensive alopecia areata (particularly alopecia totalis/universalis). For this reason, an attractive wig is an important option for some people. Proper attention will make a quality wig look completely natural; every wig has to be cut, thinned and styled, often several times. To keep a net base wig from falling off, even during active sports, special double sided tape can be purchased in beauty supply outlets and fastened to the inside of the wig. For those with completely bare heads, there are suction caps to which any wig can be attached and there are entire suction cap wig units. These state of the art wigs, which make use of a silicon base to create a secure vacuum-fit, are comfortable and easily removed by the wearer. Proper fit of a vacuum wig requires that any existing scalp hair be shaved. These wigs are generally more expensive than other types of wigs.