Alopecia areata (AA), also known as spot baldness, is a common autoimmune disorder that results in hair loss on the scalp and other parts of the body. The term "alopecia," used by physicians dating back to Hippocrates, originates from the Greek word for fox, "alopex," and was so-named due to fur loss seen in fox mange. This article delves into the pronunciation, causes, symptoms, diagnosis, and treatment options for alopecia areata, offering a comprehensive overview for those affected by this condition.
Correct pronunciation can aid communication and understanding of medical conditions. Here's a phonetic breakdown of "alopecia areata":
Therefore, the complete pronunciation is /ˌæləˈpiːʃiːə ˌɑːriˈɑːtə/.
To improve pronunciation:
Typical first symptoms of alopecia areata are small bald patches. Alopecia areata (AA) is a condition in which hair is lost from some or all areas of the body. It often results in a few bald spots on the scalp, each about the size of a coin. The underlying skin is unscarred and looks superficially normal. Although these patches can take many shapes, they are usually round or oval. Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair. Different areas of the skin may exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. In a few cases, all the hair on the scalp is lost (alopecia totalis), or all body hair is lost (alopecia universalis).
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When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp.
Alopecia areata monolocularis describes baldness in only one spot.
Alopecia areata is thought to be a systemic autoimmune disorder in which the body attacks its own anagen hair follicles and suppresses or stops hair growth. Hair follicles in a normal state are thought to be kept secure from the immune system, a phenomenon called immune privilege. For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss.
Psychological stress and illness are possible factors in bringing on alopecia areata in individuals at risk, but in most cases there is no obvious trigger.
Alopecia areata is not contagious. It occurs more frequently in people who have affected family members, suggesting heredity may be a factor. Strong evidence of genetic association with increased risk for alopecia areata was found by studying families with two or more affected members. In 2010, a genome-wide association study was completed that identified 129 single nucleotide polymorphisms that were associated with alopecia areata. controlling the activation and proliferation of regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, and Eos (also known as Ikaros family zinc finger 4), as well as the human leukocyte antigen.
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There is emerging evidence suggesting a possible link between AA and vaccinations, including influenza, zoster, and human papillomavirus (HPV) vaccines. One possible explanation is that vaccinations could trigger immune system activation, which has been observed to exacerbate preexisting autoimmune or autoinflammatory conditions in at-risk populations. A small study observed hair loss exacerbation in three patients following COVID-19 mRNA vaccinations (Pfizer-BioNTech and Moderna). These patients, who were younger on average (30.6 years) compared to unaffected individuals (37.2 years), experienced worsening hair loss within two weeks post-vaccination. Similar cases have been reported with the AstraZeneca and Johnson & Johnson COVID-19 vaccines. However, AA flares have also been linked to SARS-CoV-2 infection, either as an exacerbation of preexisting disease or a new diagnosis. In the study's non-vaccinated AA cohort, the only observed case of hair loss worsening occurred after a COVID-19 infection.
Trichoscopy may aid in establishing the diagnosis. Oftentimes, however, discrete areas of hair loss surrounded by exclamation mark hairs is sufficient for clinical diagnosis of alopecia areata. A biopsy is rarely needed to make the diagnosis or aid in the management of alopecia areata. Histologic findings may include peribulbar lymphocytic infiltration resembling a "swarm of bees", a shift in the anagen-to-telogen ratio towards telogen, and dilated follicular infundibulae. Other helpful findings can include pigment incontinence in the hair bulb and follicular stelae.
The objective assessment of treatment efficacy is very difficult and spontaneous remission is unpredictable, but if the affected area is patchy, the hair may regrow spontaneously in many cases. None of the existing therapeutic options are curative or preventive. A 2020 systematic review showed greater than 50% hair regrowth in 80.9% of patients treated with 5 mg/mL triamcinolone injections. A Cochrane-style systematic review published in 2019 showed 5% topical minoxidil was more than eight times more associated with >50% hair regrowth at 6 months compared to placebo.
In cases of severe hair loss, limited success has been achieved by using the corticosteroid medications clobetasol or fluocinonide as an injection or cream. Application of corticosteroid creams to the affected skin is less effective and takes longer to produce results. Steroid injections are commonly used in sites where the areas of hair loss on the head are small or especially where eyebrow hair has been lost. Whether they are effective is uncertain. Some other medications that have been used are minoxidil, Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy ciclosporin, sometimes in different combinations. Topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target, and small lesions typically also regrow spontaneously.
Fecal matter transplants (FMT) have been shown to reverse AA and support hair growth, with long lasting results, even going as far as growing additional hair on arms and face while grey hairs even regained colour. Hair transplantation may be an alternative for patients with chronic local alopecia areata. The fact that the disease is autoimmune and progresses with relapses is one of the biggest question marks before surgery. There have been case reports in the literature since the early 2000s. However, in an article published long-term follow-up; It is reported that the hair transplanted to the eyebrow area falls out again due to the recurrence of the disease. A similar situation was not mentioned in previous studies on this subject.
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No loss of body function occurs, and the effects of alopecia areata are psychological (loss of self-image due to hair loss), although these can be severe. Loss of hair also means the scalp burns more easily in the sun. Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Alopecia can be the cause of psychological stress.
NASCAR driver Joey Logano, obstacle athlete Kevin Bull, politicians Peter Dutton and Ayanna Pressley, K-pop singer Peniel Shin of BtoB, actors Christopher Reeve, Anthony Carrigan, Greg Grunberg and Alan Fletcher, and actresses Jada Pinkett Smith, May Calamawy, and Lili Reinhart all have some form of alopecia areata.
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