Alopecia areata is a common autoimmune skin disease that results in hair loss on the scalp, face, and sometimes other body areas, such as under the arms or on the legs. The word "alopecia" means bald, and "areata" means patchy. This condition affects approximately 2% of people worldwide, with estimates suggesting that up to 160 million individuals have or will experience it.
Anyone can develop alopecia areata, regardless of age, gender, or racial and ethnic background. While it can begin at any age, most individuals develop the disease early in life. More than 80% show signs of the disease before age 40, and 40% experience symptoms by age 20. Research suggests that women are more likely to develop alopecia areata than men, and certain racial and ethnic groups may have a higher chance of developing the disease.
It is also important to note that children can get alopecia areata, and parenting a child with the disease can be challenging.
Alopecia areata is considered a polygenic disease, meaning it is related to multiple genetic factors. About 20% of people with alopecia areata have at least one family member who also has the disease. If you have a close relative with it, the risk of alopecia areata increases. Scientists have linked a number of genes to the disease, which suggests that genetics play a role in alopecia areata. Many of the genes they have found are important for the functioning of the immune system.
However, not everyone with the genes develops the disease. The disease is a complex one. Scientists know it is an autoimmune disease, but they aren’t sure why the immune system attacks the healthy hair follicles of people with the gene variations in the first place.
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Researchers are unsure about what triggers the disease. People with alopecia areata have a genetic predisposition (increased likelihood) to it, but how is it triggered? Do the triggers first happen inside the body (from bacteria or a virus), outside the body (environmental), or a combination of both? It is possible that emotional stress or an illness can bring on alopecia areata in people who are at risk, but in most cases, there is no obvious trigger.
People with certain autoimmune diseases, such as psoriasis, thyroid disease, or vitiligo, are more likely to get alopecia areata, as are those with allergic conditions such as hay fever and atopic dermatitis (eczema). People can have one or more diseases related to alopecia areata at the same time. For example, someone can have diabetes and alopecia areata, or lupus, hypertension, and alopecia areata. But one does not cause the other.
Given that atopic disorders and autoimmune diseases also run in families, it’s important to know if you are at elevated risk for any possible comorbid conditions. If you have an autoimmune disease, like alopecia areata, you have a higher risk of getting another. The most common disease related to alopecia areata is thyroid disease. The most common one among people with alopecia areata is hypothyroidism, an underactive thyroid. This is most often caused by Hashimoto’s thyroiditis.
Type 1 diabetes, Celiac disease, Rheumatoid arthritis and Vitiligo are other diseases that can occur alongside alopecia areata.
Atopic conditions are related to allergies or a too-sensitive immune system. These diseases can also be related to alopecia areata because it isn’t uncommon for someone with alopecia areata to have at least one atopic condition too. Asthma, Allergic rhinitis, or hay fever and Atopic dermatitis are other diseases that can occur alongside alopecia areata.
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All types of alopecia areata result in some form of hair loss. If you have alopecia areata, there is no way to predict the pattern of hair loss and regrowth or how severe or long-lasting it will be. That said, there are some common symptoms of alopecia areata that are good to know and recognize.
Alopecia areata primarily affects hair, but in some cases, there are nail changes as well. People with the disease are usually healthy and have no other symptoms. Alopecia areata typically begins with sudden loss of round or oval patches of hair on the scalp, but any body part may be affected, such as the beard area in men, or the eyebrows or eyelashes. Around the edges of the patch, there are often short broken hairs or “exclamation point” hairs that are narrower at their base than their tip. There is usually no sign of a rash, redness, or scarring on the bare patches. Some people say they feel tingling, burning, or itching on patches of skin right before the hair falls out.
When a bare patch develops, it is hard to predict what will happen next. The possibilities include:
There are many different classifications of alopecia areata. The classifications depend on the amount of hair you’ve lost and where you’ve lost it on your body.
Alopecia is a common feature in several autoimmune diseases. With a wide spectrum of clinical presentations, it may manifest with a scarring or non-scarring nature, in a diffuse, patchy, or localized pattern. Identifying hair loss is of utmost importance, particularly when it represents disease activity (i.e., lupus erythematosus [LE], dermatomyositis [DM], and scleroderma).
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Hair loss is one of the most frequent manifestations of systemic lupus erythematosus (SLE), affecting approximately 50% of patients at some point in their disease. Alopecia may be the initial sign of SLE, affecting not only the hair on the scalp but also that of the eyelashes, eyebrows, and body.
The spectrum of alopecia varies from scarring alopecia, typical of discoid lupus erythematosus (DLE), to non-scarring alopecia, commonly seen in acute LE. Scarring alopecia in chronic DLE is a LE-specific cutaneous lesion in Gilliam's classification. The scalp is involved in almost 60% of cases. One-third of cases of scalp DLE progress to irreversible scarring alopecia, which negatively affects the quality of life.
DLE scalp lesions must be differentiated from lichen planopilaris, which presents as multiple coalescing areas of hair loss associated with erythema, scaling, and scarring. Patients often present with moderate to intense pruritus.
In SLE, three main clinical presentations have been described: diffuse alopecia, patchy alopecia, and lupus hair. The pathogenesis of non-scarring alopecia in SLE is not fully elucidated. High levels of proinflammatory cytokines may have a negative effect on the hair growth cycle. Complete hair regrowth occurs with SLE treatment.
Linear and annular panniculitis of the scalp (LALPS) is a rare non-scarring subtype of classic lupus panniculitis that involves the scalp exclusively along Blaschko's lines. The differential diagnosis of LALPS must be made with other causes of local non-scarring alopecia, including AA, syphilitic alopecia, trichotillomania, and SLE patchy alopecia.
Scalp involvement occurs in 63-82% of patients with DM. Associated diffuse alopecia is present in 33-87.5% of all cases. Scalp DM is characterized by erythema, scaling, poikiloderma, and non-scarring diffuse alopecia. Intense pruritus or burning sensations are key symptoms.
When the scalp is the only involved site, DM is commonly mistaken for contact dermatitis, seborrheic dermatitis, or psoriasis. If an autoimmune disease is considered, DLE must be ruled out.
Scleroderma is classified into systemic sclerosis (SSc) and localized cutaneous sclerosis (morphea). SSc has no characteristic scalp findings. Cutaneous lesions such as shiny, thickened, and smooth skin with diffuse hyperpigmentation and hypopigmentation with perifollicular sparing in a “salt and pepper” pattern may be observed. Prominent telangiectasias and diminished hair density are common findings.
Linear scleroderma en coup de sabre (LSCS) typically presents as a well-defined linear alopecic patch on the paramedian forehead or midline, following Blaschko's lines. It is usually unilateral with a shiny, atrophic, hyperpigmented, or hypopigmented appearance. It may also extend into the frontal scalp, causing irreversible scarring alopecia.
Alopecia areata is diagnosed based on your symptoms (hair loss and pattern). In addition, your doctor will want to take a family history and your medical history to rule out other things that could cause hair loss. Doctors who specialize in skin conditions, called dermatologists, treat alopecia areata. When looking for a dermatologist, look for one who is board-certified in dermatology.
For those who have more severe hair loss on their scalp or other areas of the body, there are oral and injectable medications available. These medications do not work for everyone though. There are no cure-alls that can stop or reverse alopecia areata. But you can take steps to improve your chances of reducing the immune system flare-ups that have you noticing new bald spots. You can nourish your hair and scalp.
Your healthcare provider may recommend pills, injections or creams to calm the immune response that’s causing inflammation. Some may even encourage hair growth. Options include corticosteroids and topical immunotherapy you rub onto your scalp. Both can cause side effects, so be sure to weigh the pros and cons of each with your provider beforehand.
The best course of treatment often depends on the specific disease and severity of symptoms.
Home remedies include foods that combat inflammation, like honey, onions, garlic and oatmeal.Incorporate them into your meal prep or try rubbing them onto your scalp. These foods won’t stop alopecia areata, but they’re good for your skin and hair. In addition to eating nutritious foods, you can incorporate stress-reduction techniques, like meditation, mindfulness and yoga into your routine.
Managing autoimmune-related alopecia isn't just about medical treatments-lifestyle changes can also play a critical role. Eating a balanced diet, reducing stress, and staying physically active are all essential for maintaining overall health and minimizing autoimmune flare-ups.
If you want to take stress reduction to the next level - self-care - you can get an aromatherapy scalp massage. Although more research is needed, some studies show that rubbing essential oils like thyme, rosemary, lavender and cedarwood into your scalp may help with alopecia areata.
If you are experiencing hair loss due to an autoimmune condition, consulting with a dermatologist is crucial. Dermatologists diagnose and treat various skin, hair, and scalp conditions, including alopecia linked to autoimmune diseases. Their expertise can provide you with an accurate diagnosis and recommend effective treatments tailored to your specific needs.
Dermatologists can offer a range of treatments for autoimmune-related alopecia, such as corticosteroid injections to reduce inflammation, topical treatments to stimulate hair growth, and other advanced therapies like immunotherapy. They can also help monitor your progress and adjust your treatment plan as needed to optimize results.
Unlike most autoimmune diseases, alopecia areata does not generally cause physical discomfort or disability. However, hair loss can be difficult for many people. It can have a significant impact on their mental health, affecting how they feel about themselves. Different people have different ways of coping with their hair loss. Some wear wigs or use camouflage techniques to hide the bald areas, while others don’t bother hiding it at all.
Having alopecia areata can be frustrating and emotionally challenging because hair loss and regrowth are unpredictable. But you are not alone! Mental health conditions, such as depression or anxiety, can also occur among people with alopecia areata. Several studies have found that people with alopecia areata are more likely to have anxiety or depression (or both) than people without the condition.
Living with alopecia areata can be frustrating, but several strategies can help manage the condition and its emotional impact:
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