Alopecia Areata

Alopecia areata is a disease that attacks your hair follicles (the part of your skin that makes hair). It is a common autoimmune skin disease, causing hair loss on the scalp, face and sometimes on other areas of the body. In most cases, hair falls out in small, round patches about the size of a quarter.

What causes it?

It is a polygenic disorder. This means that, unlike a single-gene disease, both parents must contribute a number of specific genes in order for a child to develop it. Because of this, most parents will not pass alopecia areata along to their children. With identical twins — who share all of the same genes — there’s only a 55% chance that if one has alopecia areata, the other will, too. This is why scientists believe that it takes more than just genetics to cause the disease and that other environmental factors also contribute to people developing alopecia areata.

Alopecia areata is an autoimmune disease, which means your immune system mistakes the normal cells in your body as foreign invaders and attacks these cells. Scientists aren’t exactly sure what “triggers” the immune system to attack healthy hair follicles when people have alopecia areata, or even if these triggers first happen inside the body (from a virus or bacteria), outside the body (from something in your surroundings) or if it’s a combination of both.

Studies have shown that environmental factors such as high stress levels, low amounts of zinc and iron in the body, trigger the condition in an individual who is already genetically susceptible.

How is alopecia diagnosed?

A pull test may be done. Your healthcare provider will tell you to not shower or wash your hair for 24 hours. He or she will gently tug on about 60 hairs. If more than 6 hairs come out, they may be sent for tests.
A punch biopsy is done to look at your scalp. Your healthcare provider will get 2 samples of scalp tissue and send for tests.
A trichogram measures hair loss. Your healthcare provider will look at hair under a microscope. He or she will measure the different stages of hair growth.
Blood tests may be done to find the cause of your alopecia.

How is alopecia treated?

The treatment for hair loss depends on the cause of your condition. Sometimes your hair loss may get better on its own and no treatment is needed. If your hair loss is related to a medicine you are taking, talk to your healthcare providers. There may be other medicines you could take instead that will not cause hair loss. If your hair loss is severe, you may need one or more of the following treatments:

Medicines:
- Hair growing agents help promote hair growth. The medicine must be used continuously until new hair grows on the affected area.
- Steroids help decrease inflammation and damage to the hair follicle. Corticosteroids may be used to treat alopecia areata.
- Estrogen is a female hormone that is used for women with hyperandrogenism (high levels of male hormones). Estrogen can reduce the effects of male hormones on hair growth. This treatment is used in women with female pattern baldness.
- Immunologic agents affect the immune system cells that may be attacking hair follicles. This treatment is used to treat alopecia areata.
- Antibiotics or antifungals may be needed if your alopecia is caused by an infection.
Hair transplant surgery removes hair follicles from one part of your head and puts them into the bald area. This is usually done only if your condition is severe and medicines fail to improve your hair loss. Ask your healthcare provider for more information about hair transplant surgery.