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Alopecia Areata:

Understanding Alopecia Areata: Causes, Symptoms, and Treatment

Alopecia areata is a common cause of sudden onset episodic non-scarring hair loss. Patients can experience a single small coin-sized patch or multiple patches. It most commonly occurs over the scalp but can involve other areas such as beard, eyebrows, eyelashes, and body hair. The skin overlying the patch can be red, itchy, or scaly. Sometimes patches may join together to involve the whole of the scalp (alopecia totalis) or loss of all body hairs (Alopecia Universalis). As this disease mostly affects pigmented or black hair so patients can feel that the patch area has suddenly developed white hairs. Nails can also develop roughness in 10-15% of the patients.

At what age does the condition of Alopecia Areata occur?

It can occur in any age group but commonly occurs in less than 40 years of age. Although does not make the patient sick, it can be a traumatizing experience for the patient. It occurs when the body’s own immunity attacks the hair bulb leading to sudden loss of hair. An episode of hair loss might be precipitated after periods of stress. Patients might have some family member who has experienced the same condition but it is not contagious. As it is an autoimmune disease, other autoimmune diseases can be associated with this such as hypothyroidism, vitiligo, psoriasis, and atopic dermatitis.

How can one diagnose if they are suffering from Alopecia Areata?

Diagnosis of alopecia areata is essentially clinical. A dermoscopic examination can help aid in the diagnosis. Investigations such as fungal culture and biopsy might be required to rule out other causes. Blood tests to rule out other autoimmune diseases can be done.

Can my hair regrow after the condition of Alopecia Areata?

Patients with small patches can regrow hair without treatment in one year in up to 80% of the cases. In 10-15% of the patients, hair loss can progress to involve the whole of the scalp or body. Prognosis is less favorable in children, patients with extensive hair loss, having a history of atopic dermatitis

How can I treat the condition of Alopecia Areata?

Single or small patches can be treated with the help of topical or injectable corticosteroids which locally suppresses the immune system which is attacking the hair bulb. Intralesional steroids might have to be repeated after a month if a patch has not resolved completely.

Other topical medicines can also be given such as minoxidil, anthralin, tacrolimus, vitamin D analogs, and topical irritants. If the patient has an extensive disease or it is not resolved with topical or injectables phototherapy or oral medicines have to be given.

Phototherapy can be done after topical application of a photosensitizing agent or after oral ingestion. It can be done with solar light or an ultraviolet light chamber. Oral medicines such as corticosteroids, cyclosporine, methotrexate, apremilast, or tofacitinib may be given to control the disease activity. Patients with extensive hair loss can benefit from wearing hairpieces, scarves, wigs, or bandanas. Eyebrow tattooing can be used to conceal the loss of eyebrow hairs.