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Alopecia areata is an unpredictable autoimmune skin disease that
affects approximately 1.7% of the US population, according to the
National Alopecia Areata
Foundation. It often appears first in childhood and its most
benign form presents as non-inflamed bald spots on the scalp. Alopecia
areata can progress to total hair loss on the scalp (alopecia totalis)
or complete hair loss all over the body (alopecia universalis).
In alopecia areata, the pattern of hair loss is usually diffuse,
and eyebrows, eyelashes and beards may also be affected. During
active hair loss, “exclamation mark” hairs are often
seen: broken-off hairs 3-4 millimeters in length that taper in width
from the end of the hair. Diagnosis of alopecia areata may be made
through a hair biopsy. Viewed under a microscope, affected individuals’
hairs usually contain lymphocytes (white blood cells) within the
hair follicles.
In the majority of cases, hair regrowth occurs spontaneously within
about one year. However, for individuals affected early in life
and/or who exhibit larger bald patches, regrowth is less certain,
and the condition may also be associated with hypersensitivity to
environmental allergens (a condition called “atopy”).
Many people affected by alopecia areata experience recurrent episodes
during their lifetime.
The underlying cause of alopecia areata, alopecia totalis and alopecia
universalis is unknown. Studies suggest that the body’s inflammatory
response somehow begins to attack hair follicles, an event that
precipitates hair loss. The process continues unless the immune
response is somehow halted, either spontaneously or with drug therapy.
Approximately 20% of affected individuals have a family history
of the condition. Moreover, the occurrence of alopecia areata is
often linked with other autoimmune conditions, such as atopy (allergy)
or lupus erythematosus.
No cure exists for alopecia areata. The most effective treatment
often includes a combination of different therapies, depending on
the extent of hair loss. In mild cases, steroid injections are given
and hair regrowth usually occurs within a few weeks. Minoxidil,
which is indicated for treating androgenetic alopecia, has also
been prescribed to treat alopecia areata. Oral cortisone is often
given to people with more significant hair loss, but is associated
with side effects over longer-term use. Topical treatments include
corticosteroids, cyclosporine
(an immunosuppressive agent) and anthralin,
a synthetic substance primarily used to treat psoriasis.
Permanent hair cosmetics are
a common drug-free approach to coping with hair loss caused by alopecia
areata.
National Alopecia Areata
Foundation
2003
National Alopecia Areata Foundation Conference
National
Registry for Alopecia Areata (NIH)
Alopecia Areata (Overview)
Harry’s Alopecia
Areata Page in the Netherlands
Eyebrowz
Alopecia Areata: Understanding and Coping with Hair Loss, by Wendy
Thompson, Jerry Shapiro, Vera H. Price, Johns Hopkins University
Press, 2000.
The Hair Loss Cure: How to Treat Alopecia and Thinning Hair, by
Elizabeth Steel, Thorsons Pub, 1999.
The Girl with No Hair: Alopecia Areata, by Elizabeth Murphy Melas,
Health Press, 2002.
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