ReverseALOPECIA Repunzel: The loss of locks Alopecia areata is an autoimmune disease, chronic in nature, with a pattern of relapsing immune-mediated inflammation of the hair follicles. This inflammatory process affects the hair follicle size resulting in it becoming smaller with associated retardation of hair production. This leads to non-scarring hair loss ranging from small patches of alopecia to the complete loss of scalp, eyebrow, eyelash, nasal hair and body hair. Hair often falls out in small round smooth patches of a few to several centimetres on the scalp with an outside perimeter of broken hair strands known as “exclamation point hairs”. These hair loss patches may develop over a few weeks. Over time the small patches can broaden and join to form irregular areas of hairless scalp, and in some cases ex- tending to other parts of the body. In a small number of people the alopecia can extend to involve the loss of all hair on the scalp (alopecia totalis) or in rare cases hair loss over the entire body (alopecia universalis). Sudden hair loss can occur, however, due to the lack of permanent hair follicle damage, in most people the hair will grow back over months and years. Once the hair grows back there can be an altered patchy pattern with the potential for repeated inflammatory episodes An important impact of DIAGNOSIS resulting in new hair loss. The extent experiencing episodes of alopecia of inflammation and associated hair is the psychosocial impact It is important to have your hair loss is unpredictable as is also the that can occur. The loss of hair, the loss episodes examined by a length of time between episodes sudden nature of the loss and the medical doctor as there are many and the time it takes for regrowth. inability to hide extensive area of conditions that can be associated hair loss can significantly impact on with Alopecia episodes and SYMPTOMS an individual’s self-esteem and lead thinning of hair. A decrease in the to emotionally challenging period number of red blood cells due to As in all autoimmune conditions, in their lives. It is not uncommon B12 deficiency (pernicious anaemia), the body’s immune system for people experiencing this inflammation of the thyroid gland, enters into a confused state autoimmune condition to experience lupus, vitiligo, as well as pregnancy, and begins to mistakenly attack periods of stress, depression and menopause, and infections of its own systems. anxiety with a sense of isolation. scalp and hair follicles can all The support of a counsellor, cause hair loss. As a basic In the case of Alopecia, the hair psychologist or simply speaking diagnostic step, your doctor follicles are targeted. Whilst the with other people living with will examine your scalp for the condition is not life threatening alopecia can help. appearance and pattern of and in general does not have hair loss. Specifically, patterns associated physical pain, the loss Causes, risk factors and prevalence of smooth patches with short of hair can cause immense The exact cause of alopecia is broken hairs around the borders psychosocial impacts as well not known, however it is believed can be characteristic of alopecia. as symptoms related to loss of that genetics as well as an protective hair coverings. environmental trigger is needed If an autoimmune condition is for a person genetically predisposed suspected, addition tests may be For example: to present with the condition. undertaken these can include: This belief is based on research that • the loss of eyelashes and nasal shows that people with a family hair can result in increased • Immunological tests of history of autoimmune diseases, irritation of eyes and nasal antinuclear antibodies in particular type 1 diabetes and passages with increased risk of • Thyroid hormones Rheumatoid arthritis, increasing your foreign body intrusion such as dust risk factors for alopecia and 20% • Iron levels of people with alopecia also report • Bare patches of skin are more • Free and total testosterone to have a close family member with susceptible to sun burn therefore • Follicle stimulating and the condition as well increased vigilance in adhering to (2 patient info UTD). luteinizing hormones common sun protection measures • Measures of inflammation such of wearing sunscreen as well as Alopecia can affect both men and as C-reactive protein and protective clothing and eyewear women and people from all ethnic are recommended erythrocyte sedimentation rate. backgrounds. It can affect all age groups, however, first time episodes •The pitting of finger and toe nails are more likely to occur before the is common therefore; adherence age of 30. Estimates of lifetime to careful hand, feet and nail care prevalence are reported to be as regimes can help reduce impacts high as 1 in 50 Other treatment options can involve the use of either oral or a topical light sensitive drug (psoralen) and subsequent exposure to a control ultraviolet light source. However, success of treatment has had mixed results reported. Additionally, the use of this treatment can increase risk factors for cutaneous malignancy. More systemic treatments such as oral glucocorticoids and other immune suppressive or immune modulating medications are usually only consider in severe cases. Alternative therapies such as acupuncture, acupuncture, vitamins and herbal supplements have been reported to be used as a treatment however, little testing of their TREATMENT effectiveness has occurred therefore treatment success is not known The overall management of alopecia needs to be a joint THE ART OF CAMOUFLAGE patient-physician plan which includes consideration involves Learning the art of camouflage, consideration of the impact of covering up with wigs, hat and Support organisations the condition and psychosocial scarves can provide relief from needs of the person experiencing appearance concerns. If milder hair Further information about hair loss episodes. Not all people loss has occurred, treating yourself alopecia areata can be with alopecia require treatment as in to a skilful hairdressing appointment obtained from: many cases the hair will regrow can teach you some camouflage without intervention. Many people techniques with hair sculpture. Alopecia UK with both short and long term For loss of eye brows and lashes www.alopeciaonline.org.uk period of hair loss opt for cosmetic application or camouflage treatments and tattooing can be helpful. National Alopecia Areata self-management of potential In some cases, the consideration foundation increased risk factors such as of shaving the scalp may be www.naaf.org sunburn or irritation of eyes considered as this can reduce the and nasal passages. patchy appearance. Shaving the Australian Alopecia Areata scalp can also allow wigs to have Foundation inc. If treatment is undertaken first better more even and secure fit. www.aaaf.org.au line therapy often includes intralesional or topical corticosteroids and/or topical References 1. Messenger AG, McKillop J, Farrant P, et immunotherapy appliedas creams al. British Association of dermatologists’ or lotions.These medications are guidelines for the management of alopecia used to treat the inflammatory areata. 2012 Br J Dermatol 2012;166:916 process that is occurring and serve 2. Alkhalifah A, Alsantali A, Wang E et al. to help reduce the increased activity Alopecia areata update:part 1. Clinical of the immune system. picture, histopathology and pathogenesis. J Am Acad Dermatol. 2010; 62:177. Hair growth stimulating agents such as minoxidil can be applied in 3. Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive the case of patchy alopecia alopecia areata. J Am Acad Dermatol 1987; however effectiveness in severe or 16:730. extensive alopecia is limited (3 in 4. Healy E, Rogers S. PUVA treatment of patient UTD). Topical minoxidil is alopecia areata –does it work? reported to promote hair growth A retrospective review of 102 cases. by increasing the growth phase of Br J Dermatol 1993;129:42. follicles and stimulating the follicles to produce hair..