Total and universal alopecia areata are rare, accounting only for 1–2% of all forms of alopecia areata. Despite the autoimmune nature of alopecia areata, there are other factors that contribute to its appearance. Such factors are:
Typically, the first symptoms are small bald patches of round or oval shape. The underlying skin in alopecia areata appears normal and non-scarred. 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 patches caused by alopecia areata are usually asymptomatic, although they may itch or be slightly painful. The disease may resolve by itself or remain constant as chronic active alopecia areata. The hairs are lost in a short period of time; cases have been reported in which the patient lost all his hair overnight. 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 nails may also suffer, displaying small pits or ridging.
Alopecia areata is often accompanied by psychological effects, such as depression and social phobia.
The diagnosis is mainly clinical. A trichogram helps to show the dystrophic anagen and increased telogen 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. Total alopecia areata occurring before puberty, frequent relapses of alopecia areata, ophiasis and coexistence of nail damage are usually associated with poor prognosis.
Alopecia areata – Treatment
Treatment is essential, as it 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, treatment of alopecia areata consists in mere monitoring of the situation, as the problem often is being resolved and the hair grows back.
Treatment of Alopecia areata with PRP
The latest development in the treatment of alopecia areata is the promising PRP method (Platelet Rich Plasma). PRP 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 in maintenance therapy as well as supplementary in combination with hair transplantation.
For PRP treatment, a small amount of blood is taken from the patient and placed in a centrifuge. The centrifugation isolates the blood plasma, which is rich in platelets. The platelets are then activated by addition of calcium chloride ions; this causes the secretion of a significant amount of growth factors which are able to stimulate the progenitor stem cells located in the hair follicle. 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.
Stages of PRP treatment for Alopecia Areata
PRP therapy is performed with a 30G microneedle, which makes it virtually painless, and no local anaesthesia is required. The PRP treatment session lasts 30-40 minutes and does not cause skin irritation. Modern PRP therapy protocols prescribe 3-4 sessions at one month intervals, while repeat sessions are recommended every 3-6 months. Clinical response to treatment with PRP 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.
PRP Treatment facts
At Advanced Hair Clinics, PRP 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 for universal and generalised forms in which the results of classic conservative therapies are usually poor. With PRP therapy, even cases of universal alopecia areata in young people with a long history of the disease (more than 5 years) who had shown no previous response to other forms of treatment, were treated successfully and have experienced excellent hair regrowth.
FUE Hair Transplantation as Alopecia areata Treatment
Hair transplantation is considered to have no general application in the treatment of alopecia areata, particularly in cases of universal alopecia areata 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, 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 place a high burden on the confidence of patients.
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.