What is Alopecia?

Everyone loses hair. It is normal to lose about 50-100 hairs each day, but if you see bald patches or lots of thinning, you may be experiencing hair loss.

If hair loss runs in your family, it is possible that you too could lose a lot more hair than what is normal. With this kind of hair loss, you may end up with bald spots if you are a man. If you are a woman, you may find that the hair on the top of your head is slowly thinning. About half of all people have this type of hair loss by around age 50.

Alopecia is a disease characterized by a rapid and sudden loss of scalp hair or other regions of the body. With this disease, the hair falls out in large quantities in certain areas, providing visualization of the scalp or skin which was previously covered by hair or body hair. It has several causes, and therefore there are several forms of treatment.

The word alopecia comes from Ancient Greek, and roughly translates to “fox disease,” on account that foxes change their fur twice a year. The word areata means “occurring in patches or circumscribed areas.”

Symptoms

Your symptoms will depend on what kind of hair loss you have. If your hair is thinning, it happens slowly over time, so you may not notice the hairs falling out. If your hair is shedding, then clumps of hair will fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area, which is called focal hair loss.

With inherited hair loss , men usually get bald spots around the forehead or on the top of the head, while women have some thinning all over the scalp, but mostly on the top of the head.

Since your hair has a lot to do with your appearance, losing it may cause you to have lower self-esteem if you don’t like how you look. This is especially true in women and teens.

The hair loss causes can be:

  • Seborrhea of the scalp;
  • Drug use;
  • stress;
  • postpartum hormonal reaction;
  • Use of inappropriate chemicals;
  • Systemic lupus erythematosus;
  • Diseases such as hypothyroidism, hyperthyroidism, secondary syphilis or lichen planus;
  • Protein deficiency, iron, zinc and biotin.
  • In addition, some types of cancer may also promote hair loss, and skin cancer, for example.

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Types

  • Alopecia areata: caused by autoimmune factors or emotional shock, characterized by severe hair loss in certain areas.
  • Androgenic: also called baldness, is caused by genetic factors associated with the testosterone level in the blood stream, and for this reason it is more common in men
  • Traumatic: caused by the fact that individuals have the habit of plucking hairs constantly or head injuries
  • Due to the side effects of drugs, for example, used to combat cancer
  • Seborrheic: caused by dermatitis, which can be treated using drugs
  • Telogen: effluvium is a normal period in which the hair falls naturally, but when this mechanism is deregulated, there may be a longer periods of hair loss, which usually respond well to clinical treatments.

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How to diagnosis Alopecia?

To diagnose it your doctor will ask you some questions, like how much hair you’re losing, when it started, and whether your parents have hair loss. He or she will look closely at your scalp and hair loss pattern and may gently pull out a few hairs for tests.

If it’s not clear what’s causing you to lose your hair, your doctor may do a blood test or look at a sample of your hair or scalp with a microscope.

There is no absolute cure for alopecia. If hair loss is caused by something that won’t last or can be treated, your hair is likely to grow back. For example, if an underactive thyroid is causing the problem, taking thyroid medicine may help. And most hair lost during chemotherapy will grow back after the treatment ends.

Hair loss that runs in the family can be treated with medicines or hair transplant surgery. Some people choose to wear hairpieces. Finding different ways of styling your hair, like dyeing or combing, also can help.

When your hair loss is inherited, your hair won’t grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won’t get all your hair back. And treatment doesn’t work for everyone.

When medicines, stress, or hair damage cause you to lose your hair, it often will grow back after you take away the cause. If this doesn’t help, you may need other treatment.

If you’re unhappy with how hair loss makes you look, treatment may help you feel better. It’s natural to want to like the way you look.

Factors that increase the risk of hair loss include:

  • Genetics (inherited tendency). If one or both of your parents have hair loss, it is likely that you will also.
  • Disease or illness. Certain diseases or an illness can cause hair loss. The diseases may include ringworm of the scalp (tinea capitis), thyroid diseases such as hyperthyroidism and hypothyroidism, or lupus. The illness may include a severe infection or high fever.
  • Many people have some hair loss by the age of 50.
  • Medicines and medical treatments. Certain medicines or medical treatments can cause scalp problems and hair loss.
  • Hair care and styling. Some methods of hair care or hair styles can damage hair and cause hair loss.

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Alopecia Areata

Alopecia areata is a common autoimmune disorder that commonly results in unpredictable hair loss. It affects 2% of Americans (roughly 6.5 million people) and can affect anyone regardless of age and gender.

In the majority of cases, hair falls out in small patches around the size of a quarter. For most people, hair loss is nothing more than a few patches, though in some cases it can be more extreme. Sometimes it can lead to the complete loss of hair on the scalp (alopecia totalis) or in extreme cases the entire body (alopecia universalis).
Alopecia areata is considered to be an autoimmune disease, where the immune system mistakenly identifies the body’s own cells instead of harmful foreign invaders. In the case of alopecia areata, the immune system attacks the hair follicles which leads to hair loss.

The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way.

While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.

Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy.

Despite what many people say, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger alopecia areata, but most recent research points toward a genetic cause.

The most prominent symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Any site of hair growth may be affected, however, including the beard and eyelashes.

The loss of hair can be sudden, developing in just a few days. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous full recovery without any form of treatment.

About 30% of individuals who develop alopecia areata find that their condition either becomes more extensive or that they experience continuous cycles of hair loss and regrowth.

Health care providers are usually able to diagnose alopecia areata fairly easily by examining the symptoms. They might look at the degree of hair loss and examine hairs from affected areas under a microscope.

If, after an initial clinical examination, the health care provider is not able to make a diagnosis, they can perform a skin biopsy. If they need to rule out other autoimmune diseases, then the health care provider can also perform a blood test.

As the symptoms of alopecia areata are so distinctive, making a diagnosis is usually quick and straightforward.

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Treatment

Unfortunately, there is currently no cure for alopecia areata, although there are some forms of treatment that can be suggested by health care providers to help hair re-grow more quickly.

The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These can be administered through local injections (most common), topical ointment application or orally.

Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE and DPCP. Although some of these may help with the re-growth of hair, they cannot prevent the formation of new bald patches. Some people turn to alternative treatment methods such as acupuncture and aromatherapy, although there is little, if any, evidence to support these treatments.

The use of photochemotherapy is supported by some studies and presents a potential alternative for patients unable or unwilling to use systemic or invasive therapies.

In addition to its aesthetic aspect, hair affords a degree of protection against the elements. People with alopecia areata who miss the protective qualities of hair may wish to:

  • Wear sunscreen if exposed to the sun
  • Wear wraparound glasses to protect the eyes from the sun and debris which the eyebrows and eyelashes would normally defend against
  • Use headwear such as hats, wigs and scarves to protect the head from the sun and keep it warm
  • Use ointment inside the nose to keep membranes moist and to protect against organisms that are normally trapped by nostril hair.

Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease which warrants treatment that addresses the emotional aspect of hair loss as well as the hair loss itself.

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