Alopecia Areata

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Alopecia areata is a disorder in which the immune system, which is designed to protect the body from foreign invaders such as viruses and bacteria, mistakenly attacks the hair follicles, the tiny cup-shaped structures from which hairs grow. This can lead to hair loss on the scalp and other areas of the body.


Contents

Other Names

Alopecia is derived from the Greek alōpekíā f. alōpēx, alōpek, which means fox. The disease was named because of a perceived resemblance to mange in foxes.

Symptoms

The primary symptom of alopecia areata is hair loss in small, round patches about the size of a quarter with smooth, hairless scalp under the patches.

In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the head (alopecia areata totalis) or complete loss of hair on the head, face, and body (alopecia areata universalis).

People with alopecia areata are generally otherwise in good health.

Diagnosis

TC/DC/ lymphocytes hair follicle cytology genetic counselling.

Causes

In alopecia areata, immune cells called lymphocytes, or white blood cells, attack the rapidly growing cells in the hair follicles that make the hair. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continually supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.

Scientists do not know exactly why the hair follicles undergo these changes. A combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger, possibly in the environment, brings on the attack against the hair follicles.

Even with the right (or wrong) combination of genes, developing alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55%. In other words, if one twin has the disease, there is only a 55% chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.

Treatment

While there is neither a cure for alopecia areata nor drugs approved for its treatment, some medications approved for other purposes can help hair grow back, at least temporarily, for some people. The following are some treatments for alopecia areata. While these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease.

Medications

Corticosteroids

Corticosteroids are powerful anti-inflammatory drugs similar to a hormone called cortisol produced in the body. Because these drugs suppress the immune system when given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be administered in three ways:

  • Local injections: injection directly into hairless patches on the scalp, and sometimes the brow and beard areas, are effective in increasing hair growth in most people. The cortisone works locally on the over-active immune response that destroys the hair follicles. This allows the hair to grow back. It usually takes about four weeks for new hair growth to become visible. Injections deliver small amounts of cortisone to affected areas. This avoids the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in skin pigmentation. Small indentations in the skin may also occur. These go away when the injections are stopped. Because injections can be painful, they may not be the preferred treatment for children. The injections usually have to be repeated monthly since the effects of cortisone wear off over time. Large areas cannot be treated, however, because the discomfort and the amount of medicine, which can cause side effects similar to those of the oral regimen, become too great.
  • Orally: Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in alopecia areata that has become extensive. Because of the risk of side effects of oral corticosteroids, such as high blood pressure and cataracts, they are used only occasionally for alopecia areata. They are also used for shorter periods of time since this decreases the likelihood that side effects will develop.
  • Topical ointments: Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections. For this reason, they are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections. They work best when combined with other topical treatments, such as minoxidil or anthralin.

Minoxidil (Rogaine)

Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children. It may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth should appear in about twelve weeks.

Anthralin (Psoriatec)

Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for twenty to sixty minutes ("short contact therapy") to avoid skin irritation. When it works, new hair growth is usually evident in eight to twelve weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.

Sulfasalazine

A sulfa drug, sulfasalazine has been used as a treatment for different autoimmune disorders, including psoriasis. It acts on the immune system and has been used to some effect in patients with severe alopecia areata.

Topical sensitizers

Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in three to twelve months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.

Oral cyclosporine

Originally developed to keep people's immune systems from rejecting transplanted organs, oral cyclosporine is sometimes used to suppress the immune system response in psoriasis and other immune-mediated skin conditions. Suppressing the immune system can also cause problems, including an increased risk of serious infection and possibly skin cancer. Although oral cyclosporine may regrow hair in alopecia areata, it does not turn the disease off. Most doctors feel the dangers of the drug outweigh its benefits for alopecia areata.

Therapies

Photochemotherapy

Photochemotherapy is a treatment used most commonly for psoriasis. A person is given a light-sensitive]] drug called a psoralen either orally or topically and then exposed to an ultraviolet light source. This combined treatment is called PUVA. In clinical trials, approximately 55% of people achieve cosmetically acceptable hair growth using photochemotherapy. The relapse rate is high and it may be difficult to schedule treatment as patients must go to a treatment center (where the equipment is available) at least two to three times per week. Furthermore, the treatment carries a risk of developing skin cancer.

Holistic and alternative treatments

When drug treatments fail to bring sufficient hair regrowth, some people turn to alternative therapies. Alternatives purported to help alopecia areata include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Because many alternative therapies are not backed by clinical trials, they may or may not be effective for regrowing hair. In fact, some may actually make hair loss worse. Furthermore, just because these therapies are natural does not mean that they are safe. As with any therapy, it may be best to discuss these treatments with a doctor. Eclipta alba may help in the form of medicated hair oil.

In addition to treatments to help hair grow, there are measures that can be taken to minimize the physical dangers or discomfort of hair loss.

  • Sunscreens are important for the scalp, face, and all exposed areas. Without hair, these areas are more prone to sunburn and sun damage.
  • Eyeglasses (or sunglasses) protect the eyes from excessive sun, and from dust and debris. These areas are more vulnerable when eyebrows or eyelashes are missing.
  • Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.
  • Antibiotic ointment applied inside the nostrils helps to protect against organisms invading the nose when nostril hair is missing.
  • Tetracycline lotion may help in bald patches over the hair.

Therapies

  1. Natural balanced diet. Avoid refined or processed foods
  2. quality protein
  3. sulfur amino acids; sources of methionine & cysteine
  4. Slant board, gravity guidance
  5. Brush & wash hair
  6. Nasal specific & cranio sacral therapy for pituitary
  7. Massage of legs
  8. Jojoba & biotin shampoo
  9. Scalp massage
  10. U.V. Woods Lamp 1-1/2 min
  11. selsun blue (Aubrey Organics has a selenium blue shampoo)
  12. biotin shampoo

Nutritional Supplements

  1. Zinc - watch Cu toxicity
  2. EFAs
  3. Vitamin B-6 - especially for females on birth control pills.
  4. Niacin - improves circulation and vasodilation
  5. Vitamin E 2000 IU
  6. Selenium 200 mg
  7. Zinc 150 mg
  8. Chromium 2mg
  9. Vitamin C to tolerance
  10. B-5 150 mg
  11. B-complex & pantothenic acid
  12. Biotin 5 mg TID -genetic enzyme deficience (rare) - linoleic acid
  13. Biotin 400-1000 mcg
  14. Folic Acid 36 mg short-term, a few people respond to this; B-12 5-6 mg
  15. Glandulars: thyroid, pituitary, adrenal
  16. Chelate if heavy metal toxicity
  17. Digestive enzymes
  18. May be excess Vitamin A
  19. Vitamin E (internal and topical)
  20. multiple vit-min with high B-complex
  21. pantothenic acid
  22. Vitamin B-12 1000mcg QD

Botanical Medicine

  1. Sage, yarrow, & nettle tea as scalp rinse
  2. Oil of bitter orange & octazone under swim cap, if non-hereditary
  3. Aloe Vera internally
  4. Cayenne - rub into the scalp (4 oz. to 1 pint grain alcohol; leave for 2 weeks, then shake daily. Strain.); cayenne tincture topically nettle rinse Propolis topical and internal Jojoba oil topically

Living with Alopecia Areata

The emotional aspects of living with hair loss can be challenging in a culture that views hair as a sign of youth and good health. Many people cope by learning as much as they can about the disease; speaking with others who are facing the same problem; and, if necessary, seeking counseling to help build a positive self-image. Most people with alopecia areata are well-adjusted, contented people living full lives.

Another way to cope with the disease is to minimize its effects on one's appearance. For total hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.

Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child's interest and mood-some even have ponytails attached.

For women, attractive scarves can hide patchy hair loss. Jewelry and clothing can distract attention from patchy hair. Proper makeup can camouflage the effects of lost facial hair. To learn more about camouflaging the cosmetic aspects of alopecia areata, a doctor or members of a local support group can recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.

Chances of Developing Alopecia Areata

Alopecia areata affects an estimated four million Americans of both sexes and of all ages and ethnic backgrounds. It often begins in childhood.

Having a close family member with the disease increases the risk of developing this disorder. Risk varies with how closely a person is related to the affected family member. [1] If the affected family member lost his or her first patch of hair before age of thirty, the risk of developing alopecia areata is greater.

Related Problems

  • In alopecia universalis, loss of eyelashes, eyebrows, and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.
  • Alopecia areata may increase a person's risk (and the risk of close family members) for developing certain diseases. These diseases include:
  • Thyroid disease
  • Vitiligo
  • Addison disease
  • Pernicious anemia

Among those affected by alopecia areata, this disorder may be protective against Type I Diabetes. However, siblings of those affected by alopecia areata may be at an increased for Type I diabetes. [2]

Clinical Trials

  • The University of Texas MD Anderson Cancer Center is leading a study that will create a national registry of alopecia areata patients and their families. The registry may be used to analyze a possible genetic link to alopecia areata. Information is available at the National Institute of Health news and events page.
  • There is also a listing of ongoing and completed clinical trials at ClinicalTrials.gov: alopecia areata

Research

While a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to prevent or even cure it.

Alopecia research ranges from the most basic studies of the mechanisms of hair growth and hair loss in mice to testing medications and ways to apply medications to help regrow hair in people. Both the National Institutes of Health and the National Alopecia Areata Foundation support research into the disease and its treatment. Some areas of research that hold promise include:

  • Developing an animal model - by developing a mouse with a disease similar to human alopecia areata, researchers hope to learn more about the mechanism of the disease and to eventually develop immune treatments for the disease in people.
  • Scientists are studying the possible genetic causes and mechanism of the disease both in families that have one or more persons with the disease and in the general population. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies.
  • By studying how hair follicles form in mouse embryos, researchers hope to gain a better understanding of hair cycle biology that may lead to treatments for the underlying disease process.
  • Several new agents found to be effective in treating psoriasis may prove to be effective in alopecia areata. These drugs work by blocking certain chemical messengers that play a role in the immune response. They also may work by interfering with the activity of white blood cells (called T-cells) that are involved in the immune system's attack on hair follicles. New therapies for treating other autoimmune diseases like rheumatoid arthritis and lupus may also benefit patients with alopecia areata.
  • One limitation of current topical therapies is getting the drug to the source of the problem. Scientists are looking for a substance that penetrates the fat under the skin to deliver medication directly to hair follicles. In laboratory animals, topically applied synthetic sacs called liposomes seem to fill the bill. Studies are still needed to show whether liposomes do the same for people.
  • Chemical messengers called cytokines play a role in regulating the body's immune response, whether it is the normal response to a foreign invader such as a virus or an abnormal response to a part of the body. Researchers believe that by giving certain inflammation-suppressing cytokines, they may be able to slow down or stop the body's abnormal response to the hair follicles. Because giving the cytokines systemically may cause adverse effects, they believe a topical medication using liposomes to get the agents to the root of the hair inside the follicle may be preferable.
  • Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells and their offspring hair follicles, scientists hope to gain a better understanding of factors that trigger the disease.

Expected Outcome

The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on their head. Some lose all the hair on their head, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.

In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.

Other Resources

Locks of Love [3] is a non-profit organization that provides hairpieces to disadvantaged children in the U.S. and Canada. The bulk of the hairpieces go to children with alopecia areata. The website gives instructions about donating hair to Locks of Love.

References

  1. ↑ van der Steen P, Traupe H, Happle R, Boezeman J, Sträter R, Hamm H. The genetic risk for alopecia areata in first degree relatives of severely affected patients. An estimate. Acta Derm Venereol.. 1992 Sep;72(5):373-5. Abstract
  2. ↑ Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter JI. Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA). Am J Med Genet. 1994 Jul 1;51(3):234-9. Abstract
  3. Locks of Love

External Links

  • American Academy of Dermatology (AAD) [1]
  • American Hair Loss Association [2]
  • American Hair Loss Council [3]
  • Children's Alopecia Project [4]
  • International Alliance of Hair Restoration Surgeons [5]
  • National Alopecia Areata Foundation (NAAF) [6]
  • The Bald Truth [7]
  • The Understand Hair Loss Organization [8]
  • Source: Medpedia content in it's entirety http://wiki.medpedia.com/Alopecia_Areata
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