Alopecia Areata and Its Extensions

Alopecia areata refers to circular patches of hair loss. There are two extensions of alopecia areata: alopecia totalis and alopecia universalis. Alopecia totalis causes hair loss from the scalp and face while alopecia universalis causes total hair loss from your scalp, face, arms, legs and body.  They are all the same problem, but the alopecia totalis and universalis are more severe.

Possible Causes of Alopecia Areata

The cause of alopecia areata is not always obvious or identifiable. I have seen many cases where we couldn’t identify the initial trigger. However, we do know of a number of possible factors that can come into play.

One is an autoimmune reaction, where white blood cells attack the melanocytes (pigment-producing cells) in the hair bulb. The hair bulb loses its ‘immune privilege’ which would normally protect it from an autoimmune reaction, and this causes inflammation around the affected hair follicles, which eventually leads to hair loss. Because white blood cells attack the melanocytes in pigmented hair, white hair (which has no melanocytes in the hair bulb) is often spared – and when the hair regrows, it is often initially white before its normal color is restored. Other triggers for alopecia areata include stress and viral infections, which result in hair loss within three months of the event. Trauma to the scalp can also lead to this type of hair loss, which I have seen in professional boxers.

Treatment for Alopecia Areata

With this type of hair loss, sometimes the hair regrows without any therapy. Obviously, that is the best case scenario. When therapy is required, its aim is to restore the hair bulb’s immune privilege so it is not susceptible to an autoimmune attack. There are several medical and non-medical therapies that can help to restore immune privilege, such as vitamin D and zinc supplements. Another treatment showing promise is the use of JAK inhibitors, which reduce inflammation and help to restore immune privilege to the hair follicles. JAK inhibitors are expensive and are still in the research stage, and we have yet to determine if improvement continues once the treatment is stopped. I will be interested to see the results of future studies into this therapy.

A Case of Alopecia Areata in The Clinic

I saw a 50-year-old female patient who had experienced an enormous amount of stress one month prior to her visit to me. She was now experiencing alopecia areata and when I gently pulled on her hair, it came out really easily. Rather than the problem being confined to a small patch it also appeared to be progressing to alopecia totalis, so I had to advise the patient that she would probably lose all her hair. However, I immediately reassured her that in all probability and based on similar cases, her hair would then regrow. I can’t emphasize enough how important reassurance is to people suffering hair loss, and if they are going to temporarily lose a lot of hair, I recommend a hairpiece to help maintain their confidence. This patient had already ordered one so she must have anticipated this outcome.

How Stress Causes Hair Loss

The stress experienced by this lady triggered a severe autoimmune reaction against her hair, which caused the growing follicles to pass prematurely into the resting ‘telogen’ stage of the hair cycle. Normally hairs remain in the telogen stage for three months before they fall out, but with alopecia areata the hair can fall within two or three weeks of the triggering trauma. I have had other cases where an allergic reaction to a hair dye has triggered extensive hair loss within a couple of weeks.

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