The word alopecia refers to any type of
hair loss,
thinning hair or
baldness
in any hairy region of the body. Baldness tends to be a more specific
term among lay people, as it usually refers to hair loss on the scalp -
however, it can mean hair loss in any part of the body.
Alopecia areata
means "hair loss in areas". In the majority of cases hair loss is a
normal process of aging, and not a disease. Because it is not seen as
life-threatening to doctors it is often disregarded. This is unfortunate
because hair loss can cause serious distress in some people, with some
far reaching psychological effects. In some cases hair loss may be a
consequence of some medical treatment, especially cancer treatment drugs - when the hair loss is generally temporary.
There are several types of alopecia, below is a list of the main types:
Alopecia areata - hair loss occurring in patches anywhere on the
body. Hair is lost from some or all areas of the body, generally from
the scalp. As it causes bald spots on the scalp, especially during its
early phase, it is sometimes referred to as "spot baldness". A small
proportion of alopecia areata
cases spread to the whole scalp, or even the entire body.
Approximately 0.1% to 0.2% of all humans are affected. It occurs in both
men and women, but more commonly among women.
Most people who develop alopecia areata are apparently healthy and have
no skin problems. When it does occur, it tends to start during the late
teenage years, early childhood, or early adulthood. However, it can
strike at any age.
Alopecia areata is not contagious. It is more commonly found among
people who have close family member who have/had it. People who have a
close relative with some kind of autoimmune disease are more likely to
develop alopecia areata. That is why most experts believe it is an
autoimmune disease - a disease where the body attacks good parts of the
body as if they were foreign undesirable objects, such as some bacteria
or viruses; in this case the body is attacking its own hair follicles.
Studies indicate that T cell lymphocytes cluster around attacked
follicles, causing inflammation
and hair loss. Scientists say something, combined with hereditary
factors, trigger the condition - we do not know what that something is,
although some suspect it may be emotional stress or a pathogen. A pathogen is a disease-producing agent, e.g. a virus, bacterium or other microorganism. A study found that there is a close relationship between infection outbreaks on teeth and the presence of alopecia areata.
Symptoms usually appear as small, soft, bald patches. They may be of
various shapes, but are generally round or oval. The scalp and beard are
the most commonly affected areas; but can occur in any hairy part of
the body. The patient may feel tingling, or even some slight pain in
affected areas. Some parts of the body may experience hair re-growth
while others will not. It can go into remission for long or short
periods, and even forever (gets better and never comes back).
When the hair falls out on the scalp it tends to do so over a short period, and more so on one side than the other.
People with this type of alopecia also have "exclamation point hairs" -
hairs that become narrower along the length of the strand closer to the
base.
Alopecia totalis - total hair loss of the scalp. This could
happen rapidly, or from progression of alopecia areata. Experts are not
sure what causes it, but know that it is an autoimmune disorder.
Although many believe mental stress is a contributory factor, a sizeable
number of people with alopecia totalis lead relatively stress-free
lives.
This type of alopecia may be an intermediary condition between Alopecia
areata and Alopecia Universalis (total body hair loss). It usually
emerges as a fairly sudden total scalp hair loss, or more gradual. When
it is gradual it tends to be a development from alopecia areata.
The majority of sufferers are either children or young adults under 40.
However alopecia totalis can affect people of any age. The patient's
nails may also become ridged, pitted or brittle in appearance.
Alopecia universalis - all hair is lost throughout the body. It
generally involves rapid loss of hair, including eyebrows and eyelashes.
Experts consider it to be the most severe form of alopecia areata. It
affects approximately 1 in every 100,000 people in North America and
Western Europe. It is an autoimmune condition.
Alopecia barbae - loss of facial hear.
Barbae comes from
Latin and refers to the bearded area of the face. It does, in fact,
affect both men and women. However, it is of more interest to men as
only men are generally bothered by it.
Alopecia mucinosa - also referred to as follicular mucinosis. It
is an inflammatory condition of both the hair follicle and sebaceous
glands (pilosebaceous unit) which can result in scarring as well as
non-scarring hair loss. Severity of scarring indicates how advanced the
disease is. There is mucin around hair follicles when examined under the
microscope. Mucins appear like stringy, clear or whitish gunk in the
skin, and are made up mostly of hyaluronic acid - this is a normal
component of the ground substance surrounding collagen of the dermis
(part of the skin).
Alopecia mucinosa generally affects the face, neck, and scalp, but can affect any part of the body.
Alopecia mucinosa can be one of three types: 1. Primary and acute
disorder - this affects children and teenagers (Pinkus type). 2. Primary
and chronic disorder - this occurs in people over 40. 3. Secondary
disorder - this is associated with benign (non-cancerous) or malignant
(cancerous) skin disease.
Experts are not sure why it occurs, but it is seen as an autoimmune
disease. Early signs include raised spots (follicular papules) which
appear in reddened plaques or patches, about 2.5 centimeters in
diameter, but they can be bigger. Some patients may start with one or
more lesions, while others may have a single lesion that develops to
multiple lesions over several weeks or months. The affected follicles
will commonly result in hair loss.
If treated early enough it is reversible - hair will grow back. In more
severe cases hair will not grow back, even after the disease has cleared
up.
Androgenetic alopecia (male pattern hair loss) - this is also
known as male pattern baldness. The hair gradually thins out, to an
almost transparent state. It can affect both men and women. Experts say
this type of alopecia is most likely to be hereditary - the person can
inherit from either the mother or the father. Androgens means hormones.
This type of alopecia is the type most lay people refer to when talking
about balding.
Male pattern baldness usually starts with a receding hairline, and/or hair loss on the top of the head.
The person has a genetically determined sensitivity to the effects of DHT
(dihydrotestosterone). Experts believe DHT shortens the growth phase
(anagen phase) of the hair cycle, causing miniaturization of the
follicles, resulting in finer hair. DHT production is regulated by
5-alpha reductase, an enzyme. DHT exists in several tissues of the body,
including the scalp.
About 50% of men are affected by this type of hair loss at some time in
their lives. Men of Chinese or Japanese ancestry are less likely to be
affected.
A Chinese study found that men who smoked were more prone to age-related hair loss.
A study identified
two genetic variants in Caucasians that together produce an astounding
sevenfold increase in the risk of male pattern baldness.
Adrogenetic alopecia (female pattern hair loss) - this is also
known as female pattern baldness. Women have a higher risk of female
pattern baldness when they undergo hormonal changes during the menopause.
The hair on the head is thinner, while facial hair may be coarser.
Although new hair is not produced, the follicles are still alive. This
suggests that hair regrowth is possible.
Generally, female pattern baldness is different from male pattern
baldness. The woman will experience hair thinning all over the head, but
will not usually lose her frontal hairline (it will not recede). Loss
of hair on the crown may be moderate, but his hardly ever progresses to
total or near baldness.
Women can lose hair for other reasons than female pattern baldness:
- Teologen effluvium (temporary shedding of hair)
- The hair may breaks after styling treatments, or the twisting and pulling of hair
- Alopecia areata
- Some skin diseases
- Iron deficiency
- Hormonal problems
- Underactive thyroid
- Vitamin deficiency
Traction alopecia - this refers to hair loss as a result of too
much pulling or tension on the hair shafts - usually the result of some
hair styles. This type of alopecia is more commonly found among women.
If the traction alopecia is prolonged the person's hair, where lost, may
never come back.
Very tight ponytails, braids, or pigtails may cause traction alopecia if
the person frequently uses them. Toy dogs whose owners use barrettes to
keep hair out of their faces may also develop this type of alopecia.
Anagen effluvium - generally brought on by the use of chemotherapy
or radiotherapy to treat cancer. Hair loss starts off as patchy, and
then becomes total. Fortunately, in the vast majority of cases, as soon
as the treatment is stopped the hair comes back within about six or so
months. Some other medications can also cause hair loss. Compulsive hair
pulling can also cause this type of hair loss, as well as poisoning
from toxic plants, and some other diseases.
Anagen effluvium is caused by sudden, profound disturbances to the matrix cells of the hair follicles.
Telogen effluvium - more than normal amounts of hair fall out. It
is characterized by excessive and early entry of hairs into the telogen
phase (resting phase). This is a temporary condition - the hair comes
back. It is thought to be caused by marked emotional or physiological
stressful events that may result in an alteration of the normal hair
cycle. The events may include childbirth, chronic illness, major
surgery, anemia, crash diets, severe emotional disorders, or drugs.
What are the treatments for alopecia?
If the hair loss is caused by an infection or a condition, treating that
infection/condition may prevent further hair loss, and in many cases
re-growth will occur.
Male-pattern baldness treatment
- Finasteride - this works by preventing the hormone
testosterone converting to the hormone DHT (dihydrotestosterone) which
causes hair follicles to shrink. Finasteride effectively brings back
normal hair size (from being very fine hair). According the National
Health Service, UK, two-thirds of males who are given finasteride
experience some hair regrowth. However, even among the other third who
experience no regrowth, most stop becoming balder. The effects of
finasteride are not evident for at least four months. If the patient
stops taking finasteride the balding process will resume.
About 1 in every 50 men who take finasteride experiences a loss of
libido (sex drive).
- Minoxidil - this is available as a lotion. The person rubs it
into the scalp on a daily basis. In the UK, and most other countries it
is available over-the-counter (no prescription needed). About 15% of
men who use it experience hair regrowth, while half of all men notice
that the balding process stops. For about 32% of all men, minoxidil
has no effect at all.
It is only after four months of daily applications that those who do
benefit from minoxidil notice it. If treatment is stopped the balding
process will resume. Side effects are uncommon.
- Laser phototherapy - a controlled clinical trial proved the
clinical efficacy and safety of a laser phototherapy device for treating
hereditary hair loss.
- Dermabrasion gel - scientists have found a way
to make the skin of laboratory mice give have fully working hair
follicles complete with new hair by using a protein that stimulates
follicle generating genes in skin cells under wound conditions.
Female-pattern baldness treatment
The only effective medication for women with female-pattern baldness is
minoxidil. About 20% to 25% of UK women who take it experience hair
regrowth, while the majority finds the treatment stops or slows the loss
of hair. Other treatments include hair transplants, wigs, hair weaving,
changes in hairstyle, plastic surgery (scalp reduction).
Alopecia areata treatment
There is no current reliable, safe, effective, long term treatment for alopecia areata, a study showed.
Fortunately, about 80% of cases resolve themselves after a year without
treatment and hair grows back. Therefore, watchful waiting may be the
best initial strategy. If it does not resolve itself, some treatments
are possible:
- Steroid injections - effective when the patient has small
patches. A steroid solution is injected straight into the scalp, several
times. The steroid stops the immune system from attacking hair
follicles. After about four weeks this treatment may stimulate regrowth.
Treatment might be repeated every few months. With some patients
alopecia returns some time after treatment is stopped, while with others
the regrowth is permanent.
- Topical steroids (creams and ointments) and steroid tablets -
although these medications are widely prescribed for alopecia areata
treatment, their long-term benefits are not clear. It seems there is a
chance hair will regrow. Side effects become more common the longer the
patient takes the steroid tablets or creams/ointments; they may include diabetes and stomach ulcers. Some patients experience itching, and sometimes hair growth in other areas.
- Minoxidil - applied in lotion form to the scalp every day,
this treatment can stimulate hair growth. Benefits, if they do appear,
do so after about two or three months. In the UK they are not
recommended for people under the age of 16.
- Immunotherapy - this is the most effective treatment for
total hair loss. DPCP (diphencyprone) is applied to the bald skin. The
patient applies the chemical solution once a week, and the dosage is
stronger each time. The DPCP generally causes an allergic reaction and
the patient will develop mild dermatitis (mild eczema).
Hair starts to regrow after about three months among patients who
respond.
Some patients may have a severe skin reaction. This can be dealt with by
reducing the rate of dosage increase. A very small percentage of
patients may develop vitiligo (patchy colored skin). Most patients find that hair continues falling out after treatment is stopped.
- Dithranol cream - this treatment is much less popular than
immunotherapy because it is less effective and there is a greater risk
of causing a skin reaction and itchiness. It can also stain the scalp
and hair.
- UV light treatment - the patient is given about two to three
sessions of light therapy each week. This is usually done in a hospital.
After about 12 months patients may see some good results. It is not
very popular as response rates are not so good.
- Tattooing the eyebrows - this is known as dermatography.
- Alternative therapies - alternative therapists commonly offer
aromatherapy, massage, or acupuncture for alopecia treatment. Not
enough studies exist to determine how effective these treatments are.
