Alopecia Areata

What is Alopecia areata?

Alopecia means loss of hair. Alopecia areata is a type of localised hair loss which is typically seen as bald patches. It may affect any hairy area of the body. It affects males and females equally. In majority of cases hair regrows after several months. It does not affect the general health of the person.

What are the causes of Alopecia areata?

Alopecia areata is considered to be an autoimmune disease. This occurs when the body’s own immune system damages its healthy cells. In Alopecia areata, white blood cells gather around the affected hair roots (hair follicles). This causes inflammation which leads to hair loss.
Genetics, atopy and environmental factors play a role. It is not a hereditary condition.


How does Alopecia areata manifest?

It typically occurs as one or more bald patches on the scalp.
It can affect any hairy area of body. Hair loss may be seen on the scalp,
beard, moustache, eyebrows, eyelashes or body hair may also be lost.
Scalp is the common site affected in 90% of the cases. Apart from the
bald patches, the scalp usually looks healthy and there is no scarring.
The bald patches are round in shape and about the size of a coin.
The nails may be affected in about 1 in 10 cases of Alopecia areata;
there may be pitting or ridging on the nails.

What is the course of the disease?

It is difficult to predict the progress of a bald patch of Alopecia areata. Usually the hair regrows within a few months. Initially it is grey or white
in colour and normal colour returns after several months. At times, one or more bald patches develop a few weeks after the first
one. Large bald patches can also develop. Patches of body hair, beard, eyebrows or eyelashes may be affected in some cases. Sometimes, the entire scalp hair is lost. This is called Alopecia totalis. In a small number of cases, all scalp hair, body hair, beard, eyebrows and eyelashes are lost. This is called Alopecia universalis.

Are there any tests to diagnose Alopecia areata?

Usually no tests are required. The diagnosis is usually confirmed by clinical examination and it is based on the typical appearance of the
bald patches. A dermatoscopy may aid the clinical diagnosis.

Blood tests may be advised to check for other auto-immune diseases and a skin scraping or biopsy may be done to rule out other causes of
hair loss.

What are the treatment options in Alopecia areata?

Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. If the hair loss
becomes more extensive then the decision on whether to treat may be considered.

Topical minoxidil solution : Applied to the bald patches and has been shown to promote hair re-growth. 

Contact immunotherapy : Topical immunotherapy is the most effective option for people with extensive Alopecia areata. Substances like diphenylcyclopropenone (DPCP) is applied on affected skin to make the skin react like an allergy or dermatitis (eczema). The skin reaction affect the process involved in causing Alopecia areata to regrow hair.

Immunomodulators : Injections of Triamcinalone acetonide into the bald patches of the scalp suppress the local immune reaction that occurs in
Alopecia areata and allows the regrowth. This treatment may be an option for one or more small- to medium-sized bald patches.
This treatment is should only done by a skin specialist.

Topical corticosteroid sparing agents such as tacrolimus can be used in sites such as eyebrows.

In refractory cases or extensive cases Minoxidil and Tofacitinib tablets have found to give very excellent results in majority of the patients.