Alopecia Areata

What's this

Alopecia areata is a chronic inflammatory pathology that affects the hair follicles of the scalp and the rest of the body. It is typically characterized by a sudden hair loss in small round or ovular patches; the temporal and occipital regions are the most commonly affected. In the most severe cases, alopecia areata affects the entire scalp (total alopecia areata) or all body hair (absolute alopecia areata).

Differences with androgenetic alopecia

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Alopecia areata affects approximately 2% of the world population (10% of that affected by Down syndrome) over the course of life.
On the other hand, "another form of alopecia, defined as androgenetic or" common ", is much more widespread, affecting approximately 80% of the male population and 50% of the female population in a more or less severe manner.
Alopecia areata, on the other hand, occurs with equal frequency in the two sexes, in all ethnic groups and at all ages, even if it prefers young adults and is rare after the age of 60. This last characteristic also represents a point of clear division from " androgenetic alopecia, which is instead typical of second adulthood and senescence.
Furthermore, in most cases (about 90%) hair that has fallen due to alopecia areata tends to grow back SPONTANEOUSLY (about 50% within a year). Despite this, the disease can recur. In androgenetic alopecia, however, the bulb hair undergoes a slow involutional process up to complete and irreversible atrophy (when this is complete there is no treatment capable of making the hair "grow back").

Causes

There are also different origins, mainly hormonal and genetic in the "common alopecia, multifactorial with an" important autoimmune and genetic component in the areata.
In fact, in alopecia areata, the cells of the immune system attack the hair follicle, thus preventing it from carrying out its function and making hair and hair grow.
It is not yet clear why the immune system attacks the hair follicles, but people with a particular genetic predisposition that is combined with other factors (severe psychological stress, iron deficiency, malnutrition) are generally affected.
For example, alopecia areata has been shown to be slightly more common in patients with other immune disorders, such as atopic dermatitis, thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, chronic atrophic gastritis, celiac disease, vitiligo, type I diabetes mellitus and various forms of allergy. Due to the severe damage caused by the immune attack, the hair follicles stop replicating, thus causing hair loss.
Both forms of alopecia are not contagious.

Symptoms

For further information: Alopecia Areata Symptoms

Naturally, the main symptom of alopecia areata is the loss of hair and / or hair in localized areas - more or less extensive - and with a rounded shape.
Apart from this, patients suffering from this disorder may also experience symptoms, such as:

Nail pitting;
Brittle nails
Dull and coarse nails;
Leukonychia.

Types of Alopecia Areata

The clinical manifestations of alopecia areata are highly variable, although the often sudden appearance of one or more patches without hair and / or hair remains typical.
Depending on the way it manifests itself, we can distinguish different types of alopecia areata, such as:

Alopecia Areata monolocularis: is a type of alopecia that occurs only in one place on the scalp.
Alopecia Areata multilocularis: occurs in multiple areas of the scalp.
Total Alopecia: it is a form that occurs all over the scalp.
Universal Alopecia: it is a type of alopecia that occurs all over the body (including eyelashes, eyebrows, armpits and pubis).This form is particularly tenacious and rarely responds to therapy.
Alopecia Barbae: it is an alopecia areata that occurs only in the beard.
Alopecia Areata Ophiasis: this particular form of alopecia areata occurs in the peripheral regions of the scalp, such as the back of the head that goes from ear to ear and / or the occipital and temporal region. The term "Ophiasis" comes from the Latin and means "snake". This type of alopecia areata has earned this particular nomenclature due to the typical sinuous shape it takes when it manifests itself.

Although hair loss is often asymptomatic, a mild itching, tingling, or burning sensation may precede the patch's development.

Care and Therapy

For further information: Medicines for the Treatment of Alopecia Areata

As mentioned, in many cases, alopecia areata tends to self-resolve and hair grows back spontaneously. However, unfortunately, this does not mean that the disorder has resolved in this way, since alopecia can appear again after some time.
When alopecia areata recurs, it becomes a particularly disabling disease from a psychological point of view, especially when the regrowth phenomena are particularly slow and / or characterized by temporary graying (the hair may be white and then gradually return to its original color). The prognosis is conditioned by numerous factors such as: age of onset, presence of familiarity, duration of the disease, extent of the patches, response to previous treatments and association with atopy or autoimmune diseases.
Adults who have only one or two patches of alopecia have the best prognosis. On the contrary, alopecia areata is more difficult and resistant when it occurs in children, has been present for more than a year, has affected the occipital region and has rapidly progressed towards a total or universal form.
The treatment of alopecia areata involves the use of various pharmacological aids, such as corticosteroids that counteract the attack of the immune system on the hair. Considering the side effects deriving from the prolonged use of these medicines, local administration is preferred (creams or lotions) than systemic (pills or injections).
Among these drugs, we remember betamethasone, fluocinonide and clobetasol.
Another active ingredient to be used topically which has proved useful in the treatment of alopecia areata - as well as in the treatment of androgenetic alopecia - is minoxidil in 5% lotion. The use of this active principle, based on a double application for at least four months, can stimulate hair regrowth.

In the most severe or extensive forms of alopecia areata, more powerful and specific drugs can be used, which however - being such - inevitably also have greater side effects. These are, for example, systemic therapies based on immunosuppressants such as cyclosporine A and the aforementioned intramuscular cortisones, including triamcinolone.
Phototherapy with UVA rays associated with the intake of photosensitizers such as psoralens (P-UVA therapy) is also commonly used in the treatment of alopecia areata, as is the excimer laser.
However, no therapeutic intervention guarantees with certainty the rapid resolution of the most severe cases of alopecia.