Social media lovers like me would have heard the story of the “slay queen” who was embarrassed when a toddler smashed the screen of her iPhoneX and pulled her wig to reveal a hair struggling with dandruff and Alopecia.
I had heard about alopecia before now but I didn’t give it much thought up till yesterday. After spending time (and data) discussing whether the “slay queen” should have slapped the toddler or not. So, I paid Google a visit.
What is Alopecia?
Alopecia is a general term for hair loss.
Alopecia areata is a specific, common cause of hair loss that can occur at any age. It usually causes small, coin-sized, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes, body and limbs can be affected.
In some cases, total baldness develops. Usually the hair regrows after several months. In some cases, the hair loss is permanent. Treatments to promote hair regrowth work in some cases, but often the hair regrows of its own accord.
Who is affected?
There are a few different ways it can affect people, but the most common is small patches of hair loss, like circles, appearing on the scalp: this is called alopecia areata.
There are other types, like alopecia totalis, where all the hair on the head is lost.
There is also something called alopecia universalis, where all the hair on the body (including the eyebrows, groin area and under the arms) disappears. But these are rare.
Alopecia areata can occur at any age but about half of cases come on in childhood and 80% of cases come on before the age of 40 years. Men and women are equally affected. The condition tends to be milder if it comes on at an older age.
Apart from the patch, the scalp usually looks healthy and there is no scarring.
Occasionally, there is some mild redness, mild scaling, mild burning or a slightly itchy feeling on the bald patches, but usually the person doesn’t feel anything.
When a bald patch first develops, it is difficult to predict what will happen. The following are the main ways it may progress:
- Quite often the bald patch or patches regrow hair within a few months. If hair grows back, it may not have its usual colour at first and look grey or white for a while. The usual colour eventually returns after several months.
- Sometimes one or more bald patches develop a few weeks after the first one. Sometimes the first bald patch is regrowing hair whilst a new bald patch is developing. It can then appear as if small bald patches rotate around different areas of the scalp over time.
- Sometimes several small bald patches develop and merge into a larger bald area.
- Patches of body hair, beard, eyebrows or eyelashes may be affected in some cases, but this is unusual.
- Large bald patches develop in some people. Some people lose all their scalp hair. This is called alopecia totalis. This is very rare though.
- In a small number of cases, all scalp hair, body hair, beard, eyebrows and eyelashes are lost. This is called alopecia universalis. Again, this is very rare.
- The nails are affected in about 1 in 10 cases and can become pitted or ridged.
What causes alopecia areata?
Alopecia areata is called an ‘autoimmune disease’. This is one of those annoying conditions where the body’s immune system, which usually fights off germs, accidentally attacks itself.
So tiny cells in the immune system, called T cells, gather around the base of a hair follicle and try to kill it. This causes the hair to fall out. But at some point the immune attack must come to an end and the hair grows back.
Alopecia areata can be triggered by a recent illness, like a viral infection, or by taking certain medications for other medical conditions. Some people can link the onset of their alopecia to a stressful life event, but many can’t. Sometimes it seems to run in families and it has been known to come on in twins at the same time. More often than not, no cause is found at all.
If you have alopecia areata you also have a slightly higher-than-average chance of developing other autoimmune diseases such as thyroid disorders, pernicious anaemia and vitiligo. Your doctor may wish to check for these if there are any signs of them along with the hair loss.
What are the treatment options for alopecia areata?
Understandably, hair loss is upsetting. Particularly in young women. So there are plenty of private clinics out there who will promise ‘instant hair regrowth’.
Be careful: a lot of treatments for alopecia are unproven, often don’t work, and can quickly become very expensive.
Not treating is a common option
In many cases, bald patches regrow by themselves without treatment. In particular, if there are just one or two small bald patches then many doctors would advise that you simply leave it alone at first.
If the hair loss is not too bad then there is a good chance that your hair will regrow after several months. Be patient: hair regrowth often doesn’t happen for a few months.
A change in hairstyle may perhaps conceal one or two small bald patches. If the hair loss becomes more extensive then the decision on whether to treat can be reconsidered. But even with extensive hair loss, there is still a chance that hair will regrow without treatment.
Note: alopecia areata itself won’t damage your general health and so not treating will not lead to any general health problems. When considering any treatment choices, you should take into account the possible side-effects that some of the treatments may have. Also, treatments promote hair to regrow and do not affect or cure the underlying cause of the condition.
Injections of steroid into the bald patches of the scalp can in theory suppress the local immune reaction that occurs in alopecia areata. This can then allow the hair follicles to function normally again for hair to regrow. This treatment may be an option for one or more small- to medium-sized bald patches. Steroid injections are thought to be the most effective treatment for patches of alopecia areata that are not too big. However, they do not work in every case.
This treatment is usually only done by a skin specialist and referral to hospital will usually be needed. Several injections (about 1 cm apart) are usually given at each session of treatment but the number is often limited by pain. Therefore, large bald areas are not suitable for steroid injections. It takes 1-2 months for the hair to start to regrow. Injections are repeated every 4-6 weeks.