Alopecia

Alopecia areata is a condition characterized by patchy hair loss, commonly manifesting as round or oval areas on the scalp, though it can occur anywhere on the body. These patches vary in size, from small and barely noticeable to large and prominent. Fortunately, many individuals experience regrowth of lost hair. This condition affects about 2% of the population inclusively, impacting all ages and genders. Experiences with alopecia areata can vary greatly; some may face a single episode of hair loss and regrowth, while others may experience multiple cycles throughout their lives. Although not life-threatening, it can profoundly impact individuals' lives. Fortunately, numerous effective medications and resources are available to manage hair loss.

Causes

• Alopecia areata is believed to be an autoimmune condition, where the immune system mistakenly targets and attacks hair follicles, disrupting normal hair growth.

• It is most commonly diagnosed in individuals during their teenage years and early twenties and is less common in those over 60.

• Both genetic and environmental factors influence the development of alopecia areata. While having a family history can contribute—approximately 25% of cases have it—it's not the sole trigger.

• In identical twins, if one sibling is affected, there's about a 55% chance the other may develop alopecia areata.

• Familial links or the presence of other autoimmune conditions, like asthma, hay fever, thyroid disease, vitiligo, and psoriasis, can increase the risk.

Symptoms

Alopecia areata presents with a range of symptoms affecting the skin, nails, and emotional wellbeing:

• Skin Changes: Patchy hair loss, often appearing suddenly on the scalp or beard, sometimes with white hairs. Hair loss can be cyclical with unpredictable regrowth, and some may experience scalp tingling or itching before hair loss.

• Hair Loss Patterns:

• Patchy Alopecia Areata: The most common form with patchy scalp hair loss and the highest chance of regrowth.

• Alopecia Totalis: Complete loss of scalp hair.

• Alopecia Universalis: Complete loss of scalp and body hair.

• Ophiasis: Loss occurs along the scalp's edges and lower back.

• Nail Changes: Affects about 65% of individuals, presenting as:

• Dents or ridges running from cuticle to tip.

• Rough nails.

• Brittle nails prone to splitting.

• Nails adopting a reddish hue.

Identifying these symptoms can assist in managing the condition effectively.

Diagnosis

Diagnosis typically involves a healthcare professional, often a dermatologist, examining the areas of hair loss and inspecting the nails. Medical history and details of the hair loss will be reviewed. A dermatoscope might be used to detect small broken hairs called "exclamation mark" hairs, indicative of alopecia areata. Tests like a gentle hair pull and microscopic examination of hair can further assess the condition. Blood tests may rule out other hair loss causes or detect other autoimmune disorders. If necessary, a skin biopsy might be conducted to distinguish alopecia areata from similar conditions like telogen effluvium.

Medications

Various medications may be considered for treating alopecia:

• JAK Inhibitors: These target immune responses contributing to alopecia. Approved options include Baricitinib (Olumiant), Ritlecitinib (Litfulo), and Deuruxolitinib (Leqselvi).

• Corticosteroids: These reduce inflammation to help hair follicles recover, available as creams, injections, or pills like Prednisone for severe cases.

• Minoxidil (Rogaine): A topical treatment promoting hair growth, best when combined with other therapies.

• Calcineurin Inhibitors: Creams that reduce immune response with fewer side effects. Products include tacrolimus (Protopic) and pimecrolimus (Elidel).

• Bimatoprost (Latisse): Originally for glaucoma treatment, it aids eyelash regrowth.

• Anthralin (Drithocreme): Applied to the affected areas to hasten regrowth through mild skin irritation.

• Methotrexate (Trexall) & Cyclosporine (Neoral): Used for severe cases, requiring regular blood checks to monitor side effects.

• Biologics: Emerging treatments showing promise, though more research is needed for widespread use.

Living

Alopecia areata poses emotional and physical challenges. Affected individuals often experience reduced self-esteem, social isolation, depression, anxiety, and may face sleep issues. Children, in particular, may experience academic and social challenges. Daily life without hair can lead to increased sensitivity to elements and hinder participation in activities. Raising awareness and having access to support networks like the American Academy of Dermatology Association or the National Alopecia Areata Foundation can significantly assist individuals and families.