The hairs are lost in a short period of time; cases have been reported in which the patient lost all his/her hair overnight. Both sexes are affected with equal frequency, and the appearance of alopecia areata is most common in children and adolescents.
Typically, the first symptoms are small bald patches of round or oval shape. The patches caused by alopecia areata are usually asymptomatic, although they may itch or be slightly painful. The underlying skin in alopecia areata appears normal and non-scarred. During the clinical examination, the hairs near the alopecia areata patch appear thin and mimic an ‛exclamation point’, as they become narrower closer to the root. In active alopecia areata, hairs are easily detached under traction, while the regrowth of hair is usually white.
The most common sites of alopecia areata are the scalp and beard, but it may occur anywhere on the skin where hair is present. The nails may also suffer, displaying small pits or ridging. The disease may be resolve or remain active as chronic active alopecia areata.
Treatment is essential, as alopecia areata causes intense stress and psychological problems for patients, which aggravate the situation. Treatment of alopecia areata is important, because patients overcome their social phobia and the quality of their lives improves. In case of small damages, the treatment consists in mere monitoring of the situation, as the problem often is being resolved and the hair grows back.
The latest development in the treatment of alopecia areata is the promising Hair Loss Treatment with autologous growth factors. This therapy has been used for many years in the treatment of wounds, burns and chronic ulcers, significantly speeding up the healing process and distinctly improving the quality of the scar. In recent years, it has been applied with great success in the treatment of hair loss, both as a maintenance therapy as well as a supplementary, combined with hair transplantation.
For autologous growth factors treatment, a small amount of blood is taken from the patient and placed in a centrifuge. The centrifugation isolates the blood ingredients. The ingredients are then activated by adding calcium chloride ions; this causes the secretion of a significant amount of growth factors which are able to stimulate the hair follicles. They also stimulate the healing power of the body at a topical level, enhancing the multiplication of cells that are essential for the process of healing and the normal function of the skin and its components.
Autologous growth factor therapy is performed with a 30G microneedle, which makes it virtually painless, and no local anaesthesia is required. The treatment session lasts 30-40 minutes and does not cause skin irritation. Modern therapy protocols prescribe 3-4 sessions at one-month intervals, while repeat sessions are recommended every 3-6 months. Clinical response to treatment varies; it can show the first results immediately, even after the first session, but usually the results become visible after the first 2-3 sessions.
At Advanced Hair Clinics, Hair Loss Treatment with autologous growth factors therapy has been and continues to be applied with great success in many cases of hair loss and alopecia of various aetiologies, mainly in cases of androgenetic or diffuse alopecia in men and women. It has also been implemented with impressive results in many cases, even in alopecia universalis and in alopecia totalis cases, in which the results of the classic conservative therapies are usually poor.
Even cases of alopecia universalis in young people with a long history (more than 5 years) who had shown no previous response to other forms of treatment, were treated successfully and have experienced excellent hair regrowth.
Hair transplantation is considered to have no general application in the treatment of alopecia areata, particularly in cases of alopecia universalis where the donor site of the scalp is insufficient to cover the needs. FUE hair transplantation can, however, be applied in selected cases of localised alopecia areata.
Most patients who are selected for this therapy present small, localised, well-defined area, demonstrate stability in the evolution of the damage, and have a fairly long history of alopecia areata (over one year), which excludes the likeliness of spontaneous regrowth of hair in the damaged area with relative certainty.
In this case, follicles are obtained from the donor site at the back of the scalp with the FUE method, and are transferred to the affected area. The growth of the hairs at their new location is gradually completed within 10 to 12 months and the results of the transplantation are excellent.
One particular case of hair transplantation with FUE, is transplantation in the eyebrows area, which are a common site of the disease, often without other affected areas on the scalp. The results of the transplantation in this case are excellent and very important for the psychology of the patient, as the loss of eyebrows tends to affect self-confidence.
FUE hair transplantation should always be carried out after providing the patient with complete and detailed information about the nature of alopecia areata, and especially the fact that it may recur in the future, in the same or another region and in an unpredictable manner in terms of time, evolution, size or location. Therefore, patients should be aware that the results of FUE hair transplantation are stable and permanent, as in other forms of alopecia, provided that the damage remains stable and does not recur in the future.
Minoxidil 5% solution is also used in the treatment of alopecia areata, usually in combination with corticosteroids. Local irritants such as tar and anthralin may help in the treatment of alopecia areata.
Topical immunomodulators may be used for treatment of alopecia areata that occurs predominantly in small patches on the scalp or face. With this treatment, the patch can be maintained stable for a long time, without expanding or recurrence.
Topical immunotherapy is one of the most important treatments of alopecia areata. It is usually applied to extensive forms of alopecia on the scalp. The agents used are diphencyprone and SADBE (squaric acid dibutylester). This treatment causes local sensitisation with these substances, which are applied progressively in increasing concentration. The allergic dermatitis caused in the region reduces the population of lymphocytes in the lesions, giving the hair a chance to grow back. The side effects of this alopecia areata treatment are irritation and enlargement of the regional lymph nodes, and it should not be used in children younger than 10 years old. Its effectiveness reaches 50%.
For the treatment of alopecia areata, PUVA light bath therapy has also been used. The effect of PUVA involves local immunosuppression, which allows the hairs to grow back again. The effectiveness of this treatment is 30% in selected cases. The side effects are burns, irritation, allergic reactions, and an increase in the probability of skin cancer. Treatment of alopecia areata with PUVA cannot be used for patients who are younger than 12 years old. Excimer laser 308 nm, acts also as an immunosuppressant but does not have the side effects of PUVA.
Anti-TNF biological agents have been successfully used to treat alopecia areata, particularly Alopecia Totalis.
Several studies are being conducted to find gene therapy for alopecia areata, and eight genes have been isolated as they are associated with the disease. These genes are also related to other conditions, such as rheumatoid arthritis and type 1 diabetes.
Finally, the use of a hair prosthesis (wig) should be taken into consideration, as it covers extensive forms and helps to improve the patient’s psychology, which is an important factor in the treatment of alopecia areata. Nowadays high-quality prostheses are available with very good aesthetic performance. Wigs can be worn for as long as needed, until the patient regains his own hair.
The autoimmune aetiology of alopecia areata is corroborated by its coexistence with other autoimmune diseases such as vitiligo, Hashimoto’s thyroiditis, Addison’s disease, and autoimmune polyendocrinopathy. It also frequently coexists with atopic dermatitis and Down syndrome. Despite the autoimmune nature of alopecia areata, there are other factors that contribute to its appearance. Such factors are:
Alopecia areata is classified as follows:
Alopecia totalis and universalis are rare, accounting only for 1–2% of all forms of alopecia areata.
The diagnosis is mainly clinical. A trichogram helps to show the dystrophic anagen and increased telogen phases of the hairs. Trichoscopy and biopsy also confirm the diagnosis of alopecia areata, as the latter will show lymphocytic infiltration and degeneration of the hair.
The prognosis is unpredictable. Alopecia areata that appears after puberty usually has a good prognosis, with regrowth in 80% of the cases within 4 to 10 months. Alopecia totalis occurring before puberty, frequent relapses of alopecia areata, ophiasis and coexistence of nail damage are usually associated with poor prognosis.