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Alopecia
Areata
Alopecia
areata is a skin disorder that typically produces one or more
patches of hair loss, most often on the scalp. Usually the bald
patches appear suddenly, affect only a limited area, and regrow
hair within 12 months or less. For some people, however, the problem
can be more chronic and more severe, producing either total baldness
(alopecia totalis) or total loss of all body hair (alopecia universalis).
The underlying
problem in alopecia areata is probably an autoimmune reaction,
in which the body's immune defenses incorrectly target and attack
the body's own cells. In this case, the targeted cells are those
of the skin's hair follicles (structures that grow hair), especially
follicles within the scalp. In addition, genetic (inherited)
factors may play a role, particularly when the disorder strikes
those under the age of 30. In this age group, almost 40 percent
of people with alopecia areata have at least one additional
family member who has been diagnosed with the same disorder.
The risk of developing alopecia areata is also unusually high
in people who suffer from asthma, hay fever, thyroid disease,
vitiligo (a condition in which patches of skin lose their color),
pernicious anemia and Down syndrome. Although experts once believed
that episodes of alopecia areata could be triggered by stress,
newer research studies have failed to prove that stress is a
risk factor for this disorder.
Approximately
1 percent to 2 percent of people in the United States develop
alopecia areata at some time during their lives. In about 60
percent of cases, the first episode of hair loss occurs before
age 20 and is followed by hair regrowth. Unfortunately, recurrences
are common, and new bald patches can develop at the same time
as the older ones are regrowing hair.
Symptoms
In its most common form, alopecia areata produces small
round or oval patches of baldness on the scalp. The area of
bald skin looks smooth and normal, with no unusual redness,
scaling or pimples. In most cases, there are no other scalp
symptoms. Occasionally, there is mild itching, tingling, tenderness
or a burning sensation in the affected area. Some people with
alopecia areata also suffer from abnormalities in the surface
of their fingernails, such as tiny pits or dents, grooves,
superficial splitting or an abnormal area of redness.
In rarer,
more severe forms of the disorder, hair loss can involve the
entire scalp or the entire body, including the eyebrows, eyelashes,
beard, underarm hair and pubic hair (hair around the genitals).
Diagnosis
Your
doctor may suspect that you have alopecia areata based on your
symptoms and, in some cases, your family history of the disorder.
To look for further evidence, your doctor will examine your
scalp and pull gently on the hairs near the margin of the bald
area. If these hairs come out very easily, the doctor will inspect
them for any obvious structural abnormalities of the root or
shaft. In some cases, a small skin biopsy of your scalp may
be done to confirm the diagnosis.
Expected Duration
In
most small patches of alopecia areata, the hair regrows spontaneously
within six to 12 months. However, recurrences are common.
Prevention
Alopecia
areata cannot be prevented.
Treatment
Although
there is no permanent cure for alopecia areata, there are ways
to short-circuit the body's autoimmune reaction in the scalp
and encourage hair regrowth. Options include:
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No
immediate treatment — Since hair usually regrows
inside the bald areas within a few months, if you have
mild hair loss you may choose to simply modify your hairstyle
or wear a hairpiece until the bald area fills in.
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Cortisone
injected directly into the bald patches to suppress the
immune reaction locally
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Topical
(applied to the surface) medications such as minoxidil
(Rogaine), anthralin (Drithocreme, Dritho-Scalp, Micanol)
or corticosteroid creams
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Topical
immunotherapy
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Psoralen
and ultraviolet A phototherapy (careful, controlled exposure
of the affected skin to ultraviolet light)
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A
short course of corticosteroids (such as prednisone) by
mouth, or rarely, intravenously (through a vein) for adult
patients with extensive hair loss |
Your treatment plan will depend on several factors, including
your age (some treatments are used only in adults), the extent
of your hair loss and your willingness to deal with any treatment-related
discomfort or side effects. If you have lost a large amount
of hair on your scalp, you may be more comfortable wearing a
wig or hairpiece until your treatment starts to work. If you
have a very obvious loss of eyebrow hair, you also may choose
to have careful injection of tiny dots of colored pigments into
the eyebrow area (a procedure called dermatography). If coping
with the change in your appearance is hard to deal with, mention
it to your physician or seek advice from a mental-health professional.
When To Call A Professional
Make
an appointment to see your doctor if:
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You
suddenly develop a bald spot on your scalp |
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Your
hair stylist tells you that your hair is thinning, or
that you have small bald areas |
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You
have lost your eyebrows or eyelashes, your beard is thinning,
or you have noticeably less hair on your underarms or
pubic area |
Prognosis
In
more than 90 percent of cases, the hair regrows and fills the
bald spot within one year, even without treatment. However,
recurrences are common, and most patients have several episodes
of the disorder during a lifetime. Only about 7 percent of patients
go on to develop severe, chronic forms of the illness that produce
large areas of hair loss with little hair regrowth.
Additional Information
National Institutes of Health (NIH)
31 Center Dr.
Building 1
Room 344
Bethesda, MD 20892-0188
Phone: (301) 496-4000
Fax: (301) 496-0017
E-Mail: nihinfo@od.nih.gov
http://www.nih.gov/
American
Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
Phone: (847) 330-0230
Toll-Free: (888) 462-3376
Fax: (847) 330-0050
http://www.aad.org/
National
Alopecia Areata Foundation
14 Mitchell Boulevard
San Rafael, CA 94903
Phone: (415) 472-3780
Fax: (415) 473-5343
E-Mail: info@naaf.org
http://www.naaf.org/
Last updated December 18, 2002
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Hereditary-Patterned
Baldness
Hereditary-patterned baldness —
or androgenetic alopecia — is the most common cause of
hair loss, affecting 30 percent to 40 percent of both men and
women. Hereditary-patterned baldness is not really a disease.
It is a natural condition caused by some combination of genetics,
hormone levels and the aging process. Hair loss typically begins
in the 20s and 30s, although in women the changes are most noticeable
after menopause.
In recent
years researchers have begun to understand more about the
cause of this type of hair loss. Under the influence of a
form of the male hormone testosterone, there is a change in
the normal cycle of hair growth, resulting in shorter, thinner
or "miniaturized" hair. Eventually, hair growth
in certain parts of the scalp stops entirely, which produces
the typical pattern of hair loss. Contrary to the folk wisdom
that baldness is inherited from one's mother's family, genes
contributed by both parents appear to affect hormone levels
as well as the general susceptibility to this process.
Symptoms
Hereditary-patterned baldness starts with thinning of
the hair and progresses to complete hair loss in parts of
the scalp. Hairs on the pillow, in the tub or on the comb
are unreliable symptoms of hair loss. The average non-balding
person loses 100 hairs per day, and more hair may fall out
under certain circumstances, such as after childbirth or
a serious illness.
In men,
the hair loss typically begins at the temples and crown
and proceeds in an M-shaped pattern. In the most advanced
stage, only a rim of hair along the side and back of the
scalp remains.
In women,
hair loss tends to be more widespread but better camouflaged.
The top of the head down the middle is most commonly affected,
often in a "Christmas-tree" pattern. In contrast
to men, the hairline along the forehead and temples usually
remains normal in women. Complete loss of hair in any one
place on the scalp is unusual and may suggest that a different
process is at work, such as alopecia
areata (an immune system disorder that causes bald patches),
a fungus infection or one of a number of skin conditions.
Diagnosis
Hereditary-patterned
baldness usually is diagnosed by both its pattern and a history
of a similar type of hair loss affecting family members. In
most people, no further tests are required.
Expected Duration
Hair
loss should be expected to be permanent.
Prevention
If you begin to lose hair in a hereditary pattern
you may be able to prevent further hair loss by using minoxidil
(Rogaine) or finasteride (Proscar). Minoxidil can be used
by both men and women, while finasteride usually is used just
for men.
Minoxidil
is a lotion, now available over the counter, that is applied
to the scalp twice daily. It prevents further hair loss
in most people within two months of starting treatment.
Within four to eight months, about 30 percent of people
will grow new hair that is long enough to be cut or combed.
Success is greatest in younger people who have just begun
to lose hair. Women appear to respond to minoxidil just
as well as men do. Better success generally is seen with
a higher-strength (5-percent) solution. One caution: If
you stop using minoxidil, you probably will lose all the
hair that was retained or restored by the medication.
Finasteride
is a prescription-only, once-daily pill that blocks the
formation of the type of testosterone that affects hair
growth. Higher strengths of the same medication are used
in men to stop benign growth of the prostate gland. Studies
suggest that finasteride helps to prevent hair loss in up
to 99 percent of men with hereditary-patterned baldness,
and that two-thirds experience some new hair growth. As
with minoxidil, any benefits from the medication are quickly
lost once it is discontinued. In addition, a small number
of men develop difficulty with sexual function.
Finasteride
does not appear to prevent hair loss in women. It also may
cause birth defects, and should not be used by any woman
who could possibly get pregnant. However, other types of
hormonal treatment (for example, certain types of birth-control
pills) may help the minority of women with hair loss who
have elevated levels of male hormones.
In some
people, hair loss may be caused by certain hair treatments
(straightening, coloring), hairstyles (tight braids) or
hair-pulling. Although these are not factors in most cases
of hereditary-patterned baldness, they may contribute to
hair loss and should certainly be discontinued.
A variety
of other creams, oils, lotions and herbal remedies for hair
loss are regularly advertised. However, only minoxidil and
finasteride have been proven effective.
Treatment
As
noted above, minoxidil and finasteride can promote new hair
growth in addition to preventing hair loss. This effect is
quite unpredictable from one person to the next.
Hair
weaves, wigs and toupees can be used. In addition, a variety
of surgical techniques also can be used, including:
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Scalp
reduction — Strips of bald skin are removed
surgically to decrease the size of a bald spot.
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Hair
flaps — A strip of skin with good hair growth
can be moved from a less cosmetically important area
to a more important one.
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Hair
transplants — Tiny plugs of skin containing
from one to 15 hairs are moved from the back or side
of the scalp to a bald area. The newer "micrografts,"
which contain very few hairs, yield the best results,
but are more expensive and time-consuming than older
types of transplants. Up to 700 individual grafts may
be necessary to complete a treatment. It may take up
to two years to see the full benefit of hair-replacement
surgery. |
Some
over-the-counter scalp treatments can cause irritation or
harm and worsen hair loss.
When
To Call A Professional
You
should call a health-care professional if you have any of
the following symptoms because they can suggest a problem
other than hereditary-patterned baldness:
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Hair
that falls out suddenly or in clumps |
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Patchy
hair loss ("flea-bitten" appearance) |
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Redness,
flaking or scarring of the scalp in the area of hair
loss |
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Hair
loss in women under age 30 |
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Signs
of abnormally high testosterone levels in women, including
abnormal menstrual periods, deepening of the voice,
acne, hair loss in a male pattern or hair growth in
unusual places (face, chest) |
Most primary-care
physicians or dermatologists will prescribe finasteride to
men who would like to use it. If you are interested in cosmetic
surgery, you should consult a cosmetic surgeon or dermatologist
who specializes in hair restoration.
Prognosis
Unless
a preventive treatment is started, hereditary hair loss becomes
more pronounced over time. Generally, the earlier hair loss
begins, the more severe it will become. As noted above, preventive
treatment with minoxidil or finasteride must be continued
indefinitely to maintain results.
Additional Information
American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
Phone: (847) 330-0230
Toll-Free: (888) 462-3376
Fax: (847) 330-0050
http://www.aad.org/
American
Society of Plastic Surgeons
444 E. Algonquin Rd.
Arlington Heights, IL 60005
Toll-Free: (888) 475-2784
http://www.plasticsurgery.org/
Last updated July 27, 2003
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This
health article is made available by
Dr. Eliot Y Ghatan MD a Dermatologist. AESTHETIC SURGERY &
DERMATOLOGY office at 1226 Ocean Parkway, Brooklyn, NY 11230.
Dr. Ghatan is easy reachable from Breezy Point, Bronx, Brooklyn,
Connecticut, Far Rockaway, Howard Beach, Long Island, Manhattan,
New Jersey, Queens, Ridgewood, Rockaway Park, and Staten Island.
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