Alopecia Areata

(common misspellings: alopecia aereata, alopecia ariata, alopecia areta, alopecia areota)

Alopecia Areata is an autoimmune skin disease that causes the body's immune system to attack the hair follicles, causing baldness in patches. It affects 1.7 percent of the population, including 4.7 million people in the United States.

Alopecia areata is thought to be an autoimmune disease that makes the body to treat its hair follicles as foreign tissue and suppress or stop hair growth. It is not contagious but may be hereditary - there are a few recorded cases of babies being born with congenital alopecia areata. Stress has not been proven to be a crucial factor.

Alopecia areata monolocularis describes baldness in only one spot, alopecia areata multilocularis refers to multiple areas of hair loss. In cases where the disease progresses to the point where all scalp hair is lost, it is called Alopecia Totalis, and where hair loss advances to the entire body it is called Alopecia Universialis. The disease may also be limited only to the beard (alopecia areata barbae).

Hair loss with alopecia areata comes in stages, with hair returning and falling out in phases.

First symptoms are small, soft, bald patches which can take just about any shape but are most usually round. Initial presentation most commonly occurs in the late teenage years but can happen with people of all ages. It most often affects the scalp but may occur on any hair-bearing part of the body. There may be different skin areas with hair loss and regrowth in the same body at the same time. It may go into remission for a time or permanently. The longer the hair loss persists, the smaller the chance that it will grow back. Fingernails may be affected, especially in severe cases where various nail changes may appear, the most common of which would be pitting of the fingernails.

Episodes of alopecia areata before puberty predispose to recurrent episodes after puberty. Pitting of the fingernails can hint at a more severe or prolonged course.

Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies and atopic dermal ailments and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions. They may also have aberrant nail formation because keratin forms both hair and nails.

There is no cure for alopecia areata. If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. Initial stages may be kept from increasing by applying topical corticosteroids. In cases where there is severe hair loss, there has been limited success treating alopecia areata with steroids (intradermal, topical or oral), other immune modulators, minoxidil or phototherapy.

Hair implants may help covering bald spots, but cannot guarantee satisfactory outcome, since the bald areas might expand. Wigs should be prescribed if patients, especially female patients, mention social discomfort.