Alopecia Areata: Causes, Symptom and Treatment

Introduction

Alopecia areata is an autoimmune issue that leads to quick, patchy loss of hair on the scalp, face, and maybe other body parts. It happens when the immune system wrongly attacks hair follicles, causing hair to fall out in round spots.

The exact reasons for alopecia areata are not clearly known but likely involve a mix of genetic and environmental factors.

Anyone can get alopecia areata, but it often starts in kids or teens. It’s an ongoing, unpredictable issue that can deeply affect mental health, especially if hair loss is large or happens often.

Causes

The exact cause of alopecia areata is not clearly defined, but research suggests it is an autoimmune problem influenced by various genetic, immune, and environmental factors.

• Autoimmune Response: In alopecia areata, the immune system incorrectly sees hair follicles as threats, causing inflammation and hair loss. Immune cells called T-cells gather around hair follicles, affecting their function and stopping hair from growing.
• Genetics: Family background plays an important role, as those with a family history of alopecia areata or other autoimmune diseases are more likely to develop it. Research has pinpointed certain genes linked to immune function that may raise the risk.
• Environmental Triggers: The specific triggers are unclear, but stress, trauma, viral infections, and certain environmental influences are thought to play a part in starting or worsening the condition. These factors might prompt the immune system in those who are genetically at risk.

Symptoms

Alopecia areata is marked by unexpected hair loss that usually shows up as round or oval patches. The condition generally causes no pain and does not result in scarring.

Symptoms include:

• Patchy Hair Loss: Quick, round bald spots can appear on the scalp, beard, or other places. Sometimes, these patches can join to create larger bald areas.
• Exclamation Mark Hairs: Short, broken hairs that narrow at the bottom, looking like exclamation marks, are often found at the borders of bald spots.
• Nail Changes: In some cases, alopecia areata can affect nails, causing pitting, ridges, or roughness.
  Regrowth in White or Fine Hair: When hair starts to grow back, it might first appear as fine, white strands, which can gain pigment over time.

The severity of alopecia areata can differ, with some people having just one incident while others may face ongoing or worsening hair loss, which can lead to conditions like alopecia totalis or alopecia universalis.

Risk Factors

Several risk factors can raise the chances of developing alopecia areata:

• Family History: Having family members with alopecia areata, other autoimmune diseases (like lupus, rheumatoid arthritis, or type 1 diabetes), or thyroid issues increases risk.
• Other Autoimmune Disorders: Individuals with autoimmune conditions such as vitiligo or thyroid disease face a higher chance of getting alopecia areata.
• Age: While alopecia areata can occur at any age, it is seen more often in children and young adults.
• Stress: Emotional or physical stress may trigger the beginning or return of alopecia areata, but it is not seen as a direct cause.

Differential Diagnosis

Alopecia areata might look like other hair loss conditions, so it is important to carefully differentiate it to rule out similar issues:

• Tinea Capitis: This is a scalp fungus that can cause loss of hair, often linked to flaky skin and itching. It is mainly found in kids and can be identified through fungal tests.
• Androgenetic Alopecia: Also referred to as male or female pattern baldness, this hereditary issue causes slow, consistent hair loss in specific patterns, unlike the irregular loss seen in alopecia areata.
• Trichotillomania: This is a hair-pulling condition that leads to uneven hair loss with jagged edges. It’s frequently seen in young people and can involve psychological issues.
• Scarring Alopecia: This category includes hair loss issues where inflammation damages and scars hair follicles, which is different from non-scarring alopecia areata.
• Telogen Effluvium: This kind of hair loss is temporary and linked to stress, sickness, or hormonal shifts, mostly leading to widespread shedding instead of distinct bald areas.

Investigation

To diagnose alopecia areata, a clinical exam is usually sufficient, but more tests might be needed to exclude other issues:

• Clinical Examination: Doctors look for distinct round or oval bald patches, exclamation mark hairs, and changes in nails, sometimes using a dermatoscope to observe the scalp closely for signs.
• Hair Pull Test: This test involves gently tugging at a small hair section to see if any hairs come out easily, which shows active hair loss.
• Scalp Biopsy: If the diagnosis isn’t clear, a scalp biopsy can help confirm it. This test typically shows a “swarm of bees” pattern, with lymphocytes surrounding hair follicles, which is typical of alopecia areata.
• Blood Tests: Tests might be done to rule out other autoimmune diseases or deficiencies. Tests for thyroid function, antinuclear antibodies (ANA), and complete blood counts may be done if there’s a concern about related autoimmune issues.
• Trichoscopy: This is a non-invasive method for looking closely at the scalp and hair follicles, aiding in differentiating alopecia areata from other hair loss types.

Treatment

There’s no cure for alopecia areata at present, but there are various treatments to help hair regrowth and manage symptoms. Treatment choices depend on the severity of hair loss, age, and personal preferences.

• Topical Corticosteroids: Treatments like corticosteroid creams, ointments, or lotions are commonly given to lessen inflammation around hair follicles. They are especially effective for mild cases and can be used with other treatments.
• Intralesional Corticosteroids: For small patches, corticosteroid injections in the affected areas can help hair regrow. This method is often effective for limited hair loss areas.
• Topical Immunotherapy: For more severe hair loss, solutions like diphenylcyclopropenone (DPCP) or squaric acid dibutylester (SADBE) can be put on the scalp. These substances create a mild allergic reaction, believed to shift the immune system’s response and encourage hair regrowth.
• Minoxidil: Topical minoxidil can be used alongside other treatments to promote hair growth. While it doesn’t influence the immune system, it may increase hair thickness.
• Oral Corticosteroids: For severe issues like alopecia totalis or universalis, systemic corticosteroids may be recommended. However, long-term use is limited due to potential side effects such as weight gain, high blood pressure, and a higher chance of infections.
• JAK Inhibitors: Drugs like tofacitinib and ruxolitinib, known as Janus kinase (JAK) inhibitors, have shown potential in new studies for treating alopecia areata by dampening immune activity. Though still being researched and not widely approved, they are available in some cases and have shown promising results.
• Platelet-Rich Plasma (PRP) Therapy: This Therapy uses the patient’s own platelet-rich plasma, injecting it into the scalp to possibly encourage hair regrowth. PRP is seen as experimental but is becoming popular as a treatment option.
• Lifestyle Changes and Stress Control: Stress can worsen alopecia areata, so reducing stress through methods like mindfulness, exercise, and therapy could help with symptoms and lower chances of recurrences.
• Wigs and Cosmetic Options: For those with major or extended hair loss, wigs, hairpieces, and eyebrow tattoos can create a feeling of normalcy and help reduce emotional pain.

Conclusion

Alopecia areata is a complex autoimmune issue that can greatly affect those who have it. It is known for sudden, patchy hair loss and presents special challenges for diagnosis and treatment.

The exact cause is not well understood, but there’s a clear link between genetics and environmental factors. Although a complete cure is not available, many treatments, including corticosteroids and JAK inhibitors, can assist in managing symptoms and encouraging hair growth.

Proper management also requires emotional support to help people deal with the effects of hair loss. Continued research is expected to lead to better understanding and new treatments for this condition.