Hair loss is undesirable to most people. But whether they like it or not, a healthy adult loses 50 to 100 strands everyday and this is a normal phenomenon. However, certain health conditions can cause excessive hair loss, which can be a reason for physical and emotional distress  — alopecia is one of them.

What is alopecia areata?

Alopecia areata is a condition characterized by patches of hair loss on the scalp or other areas of the body like the beard or pubic region. The degree and pattern of hair loss may differ from person to person. In some cases, this condition can eventually lead to total hair loss on the scalp or other areas of the body. The condition can develop at any age, but most cases tend to develop by the age of 30 years.

Initially, the patches of hair loss may go unnoticed. However, over time as the patches connect, the hair loss becomes more noticeable. 

Even though the immune system attacks the hair follicles, they rarely destroy the follicles. Therefore, it is possible for hair to regrow. The extent of hair loss and hair regrowth may differ from person to person. In many cases, hair may regrow on its own on the bald patches. In others, the same hair may fall again after some time.

What are the risk factors?

Alopecia areata can affect anyone. However, some factors may increase the risk of developing this condition.

Family history: Having a close blood relative with alopecia areata may increase your chances of developing the condition.

Other health conditions: Research suggests that people with conditions such as asthma, atopic dermatitis, thyroid conditions, Down syndrome, or vitiligo may be at higher risk of developing alopecia areata.

In several cases, no specific cause has been implicated for the onset of an episode of alopecia areata. However, certain factors that may have triggered the episode have been suggested. These include stress, drugs, and certain types of fevers.

Symptoms of alopecia areata

While hair loss on the scalp is common in alopecia areata, hair loss on other parts of your body like eyebrows, eyelashes, or beard regions in men may also occur.

• Sometimes the only sign is sudden hair loss
• One of the most common, early signs of alopecia areata are round or oval bald patches on the scalp. The patches may be of different shapes. They may grow larger and connect with adjacent patches  to form a large bald spot
• Hair may regrow in a bald spot while it may start to fall out in a different area
• Hair loss may happen during colder periods; cold weather may be a trigger for this condition
• Generally, in alopecia areata, the hair loss occurs without any rashes, redness, or scarring. However,  some people with alopecia areata have reported experiencing itching, burning, or tingling on the affected area before the hair falls off.  In certain cases, individuals may develop ophiasis, a strip of bald skin along the circumference of the scalp
• Affected people may have very little hair left on the head or may lose all hair on the head
• Eyebrows, eyelashes, or both may be partially or completely lost
• Some people, who have alopecia areata may experience changes to their nails, like red nails, pits in the nails, ridges in the nails, or nails that are rough to touch

Management of alopecia areata

Since the condition may affect people differently, the treatment of alopecia areata will also vary. No one treatment may suit everyone; types of treatments or medications may be required. Factors like age, the extent and regions of hair loss will determine the treatment regimen.

Generally, the aims of the treatment are to block the immune system from attacking the follicles and/ or to stimulate hair regrowth. In individuals with limited hair loss, or if the condition has lasted only for a short duration, remission may occur. However, cases of long-standing alopecia areata with extensive hair loss may not respond very favorably to most treatments.  

Corticosteroids: Topical steroids in the form of a lotion or shampoo may be used in some cases of patchy alopecia areata to hasten hair regrowth. In some patients, steroids injected directly into the lesions may also be helpful in stimulating hair growth at that particular site. Oral steroids may be useful in cases of severe alopecia areata.

Contact immunotherapy: In this therapy, a chemical is applied to the bald skin to sensitize it and elicit a reaction to subsequently enable hair regrowth.

Cosmetic: Some people with alopecia areata may choose to use wigs, hairpieces, or other hair accessories. Shaving their heads or semi-permanent tattooing to compensate for the loss of eyebrows may also be opted by some patients.

Counseling: For some patients, alopecia areata, especially with extensive hair loss, may impact psychological well-being. In such cases, consulting a clinical psychologist or mental healthcare professional may provide patients with the much-needed support to cope.

There are several factors at play in the development of alopecia areata — it may not be possible to identify a single cause. Therefore, there are no definitive preventive measures. Although there is no cure for alopecia areata, there are many treatment options available to reduce the severity or facilitate hair regrowth. There are also several resources available to deal with the stress accompanying the condition and ways to cover up any hair loss.

References
1. Pratt CH, King LE Jr, Messenger AG, et al. Alopecia areata. Nat Rev Dis Primers 2017; 3: 17011.
2. Hair Loss Types: Alopecia Areata Overview. American Academy of Dermatology Association. https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes (accessed May 18, 2021).
3. Treatments for Alopecia Areata. National Alopecia Areata Foundation. https://www.naaf.org/alopecia-areata/alopecia-areata-treatments (accessed May 18, 2021).
4. Everything You Need to Know About Alopecia Areata. Healthline. https://www.healthline.com/health/alopecia-areata (accessed May 18, 2021).