Alopecia Areata

What is alopecia areata and who gets it?

Alopecia means loss of hair or baldness. There are several different causes and patterns of hair loss. Alopecia areata is one type of hair loss which affects about 1 in 100 people. It usually develops in teenagers and young adults, but can occur at any age. Men and women are equally affected.

What are the symptoms of alopecia areata?

The typical pattern is for one or more bald patches to appear on the scalp. These tend to be round and about the size of a large coin. They develop quite quickly. A relative, friend, or hairdresser may be the first person to notice the bald patch(es). Apart from the hair loss, the scalp looks otherwise healthy. There is no redness, itching, scaling, scarring, or other symptoms. When a bald patch of alopecia areata first develops, it is impossible to predict how it will progress. The following are the main ways it may progress.

• Quite often the bald patch or patches re-grow hair within a few months. In some of these cases one or more bald patches may recur sometime in the future.
• Sometimes one or more bald patches develop a few weeks after the first one. Sometimes the first bald patch is re-growing whilst a new bald patch is developing. It can then appear as if small bald patches rotate around different areas of the scalp over time.
• Sometimes several small bald patches may develop together and merge into a larger bald area.
• Patches of body hair, beard, eyebrows, or eyelashes may be affected in some cases.
• Large bald patches develop in some people. Some people lose all their scalp hair. 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.
• The nails are sometimes affected and become pitted or ridged.

If hair grows back it may not have its colour at first and look grey or white. The usual colour eventually returns.

What causes alopecia areata?

Alopecia areata is thought to be an auto-immune disease. The immune system makes white blood cells (lymphocytes) and antibodies to attack bacteria, viruses, and other 'bugs'. If you have an auto-immune disease, your immune system attacks part(s) of your body. In alopecia areata, many white blood cells gather around the hair roots (hair follicles) in the bald patches.

It is not known why only certain areas of the scalp are affected. It is also not clear how the immune system affects the hair follicles. In some way it makes the hair weak and thin which breaks very easily. Therefore the hair does not grow out of the scalp or skin. The affected hair follicles remain alive and are capable of making normal hair again if the situation returns to normal.

It is not known why alopecia areata or other auto-immune diseases occur. It is thought that something triggers the immune system to attack the body's own tissues. Possible triggers include: viruses, infection, medicines, sunlight, or other environmental factors. There is also an inherited factor which makes some people more prone to auto-immune diseases. About 1 in 5 people with alopecia areata have a close relative who is also affected.

If you have alopecia areata you also have a slightly higher than average chance of having other auto-immune diseases such as thyroid disorders, diabetes, or vitiligo. (However, it is important to stress that most people with alopecia areata do not have any of these other conditions.)

What are the treatments for alopecia areata?

Various treatments have been tried, usually with only limited success. Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. It is difficult to gauge how much treatment affects hair re-growth.

• Not treating is a common option if there are just one or two small bald patches. A change in hairstyle may perhaps conceal one or two small bald patches.
• Steroid injections into the scalp next to areas of baldness will often stimulate hair to re-grow. Steroids suppress the immune system. Steroid injected into a bald patch suppresses the localised immune reaction that occurs in alopecia areata. This treatment may be an option for a small bald patch that is difficult to conceal. However, large bald areas are not suitable for this treatment.
• Minoxidil solution rubbed into the bald areas has been shown to promote hair re-growth in some cases. This is the same treatment used for the common 'male pattern' baldness. It is not known how it works. The success rate is not high.
• Irritant creams such as dithranol have been shown to promote hair re-growth in some cases. Again, the success rate is not high but one study suggested that dithranol helps in about about 1 in 4 cases. Side-effects such as itchiness, redness, and scaling are common with dithranol.
• Other treatments such as steroid creams and phototherapy have been tried with some limited success.

What is the outlook (prognosis) for people with alopecia areata?

• In about 1 in 3 cases, there is only one small bald patch which grows back within several months, and then there are no further recurrences.
• In about 2 in 3 cases patchy baldness may come and go over many years. The size of the bald patch(es) and the duration they last is quite variable.
• A small number of people develop permanent and total baldness.
• Treatment may help to promote hair re-growth in some cases.

Further help and advice

Hairline International (The Alopecia Patients' Society)
Lyons Court, 1668 High Street, Knowle, West Midlands, B93 OLY.
Tel: 01564 775281 Web: www.hairlineinternational.co.uk

© EMIS and PIP 2004   Updated: May 2002   CHIQ Accredited