Alopecia

Alopecia areata is a condition marked by hair loss in patches, often appearing as round or oval bald spots on the scalp, though it can also affect any other hairy part of the body. The size of these patches can range from small and almost unnoticeable to larger areas. For many individuals, hair eventually regrows. Affecting up to 2% of the population across all ages and genders, alopecia areata manifests differently for everyone. Some may encounter only one episode, while others might experience multiple cycles of hair loss and regrowth throughout their lives. While not life-threatening, alopecia areata can profoundly affect one's life. A variety of treatment options exist, and resources are available to help individuals cope with the emotional aspects of hair loss.

Causes

Alopecia, leading to hair loss, can be caused by multiple factors:

• Autoimmune Factors: Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles. The likelihood increases with a family history, affecting 25% of individuals with relatives having the condition. Identical twins show a 55% concordance rate.

• Genetic Influences: Androgenetic alopecia, the most common form, is hereditary and follows predictable patterns.

• Environmental Triggers: Stress and certain lifestyle factors are known contributors.

• Medical Conditions: Other autoimmune disorders, like asthma, thyroid disease, or vitiligo, may increase risk.

• External Contributors: Tight hairstyles can cause traction alopecia.

• Other Causes: Hormonal changes, medical treatments like chemotherapy, nutritional deficiencies, scalp infections, and certain skin conditions also contribute.

These factors can impact hair loss differently, requiring potential management or medical intervention.

Symptoms

Alopecia, particularly alopecia areata, presents with various symptoms affecting both skin and nails:

• Sudden Hair Loss: Begins with smooth, round, or oval bald patches on the scalp and possibly beard, eyebrows, or eyelashes.

• Patterns of Hair Loss:

• Patchy Alopecia Areata: Scattered patches with likely regrowth.

• Alopecia Totalis: Complete loss of all scalp hair.

• Alopecia Universalis: Total loss of all body hair.

• Ophiasis: Hair loss around the scalp's sides and lower back.

• Sensations: Tingling or itching may precede hair loss.

• Nail Changes: About 65% of those affected experience nail changes, including:

• Tiny pits or ridges.

• Rough or sandpaper-like texture.

• Brittle nails prone to splitting.

• Red-tinged nails.

These symptoms, while primarily involving hair loss, may also include nail and skin sensations.

Diagnosis

Diagnosis involves a healthcare provider, typically a dermatologist, who will examine hair loss areas and potentially inspect the nails. Details about medical history and hair loss patterns are discussed. A dermatoscope might be used to check for "exclamation mark" hairs, or a gentle pull test to examine shed hairs microscopically. Blood tests may identify other causes or related autoimmune conditions. Occasionally, a skin biopsy is performed, involving numbing the area and lab analysis, to differentiate it from similar conditions like telogen effluvium.

Treatments

While a permanent cure for alopecia areata is unavailable, several treatments help manage the condition. Corticosteroids, administered through injections, oral medications, or topical applications, help reduce inflammation and promote regrowth. Minoxidil, a topical treatment, also aids hair regrowth over weeks. Other options include phototherapy and platelet-rich plasma injections. For persistent cases, JAK inhibitors are considered. Consulting with a healthcare professional is essential to tailor effective treatment personally.

Medications

Various medications support hair regrowth and manage the immune response in alopecia:

• JAK Inhibitors: Newer medications like Baricitinib work by blocking certain immune pathways.

• Corticosteroids: Reduce inflammation, available in creams or oral forms for severe cases.

• Minoxidil: Topical application to encourage hair growth.

• Calcineurin Inhibitors: Moderate immune response, suitable for sensitive areas.

• Bimatoprost: Promotes eyelash regrowth.

• Anthralin: May cause irritation but supports hair regrowth.

• Methotrexate & Cyclosporine: Used in severe cases but require monitoring.

• Biologics: Emerging treatments needing further study.

Each medication offers specific benefits and requires a personalized approach under medical guidance.

Living

Alopecia areata significantly affects emotional well-being and social life, often causing low self-esteem and isolation. It is linked to sleep issues, depression, and anxiety, particularly impacting children, influencing school and family dynamics. Challenges include runny noses, sneezing, eye irritation, or sunburn. Public awareness and support networks can aid those affected. Information is available from the American Academy of Dermatology, National Alopecia Areata Foundation, and National Institutes of Health.

Prevention

Complete prevention of alopecia areata isn’t possible since it arises from an autoimmune response. However, certain measures can help reduce triggers and support hair health:

• Handle hair gently.

• Avoid tight hairstyles.

• Protect from sun and harsh chemicals.

• Manage stress.

• Maintain a balanced diet.

These steps aid in minimizing additional hair loss but cannot fully prevent alopecia areata.