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Alopecia Areata
What Is Alopecia Areata?
Alopecia areata, pronounced al-oh-PEE-shah ar-ee-AH-tah, is a disease that affects the hair follicles, which are part of the skin from which hairs grow.
In most cases, hair falls out in small, round patches about the size of a quarter. Many people with the disease get only a few bare patches. Some people may lose more hair. Rarely, the disease causes total loss of hair on the head or complete loss of hair on the head, face, and body.
Who Gets Alopecia Areata?
Anyone can have alopecia areata. It often begins in childhood. There is a slightly increased risk of having the disease if you have a close family member with the disease.
What Causes Alopecia Areata?
Alopecia areata is an autoimmune disease. Normally the immune system protects the body against infection and disease. In an autoimmune disease, the body's immune system mistakenly attacks some part of your own body. In alopecia areata, the immune system attacks the hair follicles.
The cause is not known. Scientists think that a person's genes may play a role. For people whose genes put them at risk for the disease, some type of trigger starts the attack on the hair follicles. The triggers may be a virus or something in the person's environment.
Will My Hair Ever Grow Back?
There is every chance that your hair will grow back, but it may fall out again. No one can tell you when it might fall out or grow back. You may lose more hair, or your hair loss may stop. The hair you have lost may or may not grow back. Even a person who has lost all of his hair may grow all of his hair back. The disease varies from person to person.
How Is Alopecia Areata Treated?
There is no cure for alopecia areata. There are no drugs approved to treat it. Doctors may use medicines approved for other diseases to help hair grow back. Talk to your doctor about the treatment that is best for you. The following are some treatments for alopecia areata. They may help hair grow back, but none of them prevent new patches of hair loss or cure the disease.
Corticosteroids:
Corticosteroids are drugs that reduce swelling and pain. They also affect the immune system. Corticosteroids may be given in three ways for alopecia areata:
- Injected in the skin - Injections of steroids directly into hairless patches on the scalp and sometimes the brow and beard areas are effective in increasing hair growth in most people. It usually takes about 4 weeks for new hair growth to become visible. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped. Because injections can be painful, they may not be the preferred treatment for children. After 1 or 2 months, new hair growth usually becomes visible, and the injections usually have to be repeated monthly. The cortisone removes the confused immune cells and allows the hair to grow. Large areas cannot be treated, however, because the discomfort and the amount of medicine become too great and can result in side effects similar to those of the oral regimen.
- Swallowed as pills - Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in more extensive alopecia areata. But because of the risk of side effects of oral corticosteroids, such as hypertension and cataracts, they are used only occasionally for alopecia areata and for shorter periods of time.
- Rubbed on the skin as a cream or ointment - Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections - they work best when combined with other topical treatments, such as minoxidil or anthralin.
Drugs that are rubbed on the skin as a cream or lotion include:
- Minoxidil 5% (Rogaine ®) - Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth appears in about 12 weeks.
- Anthralin (Psoriatec ®) - Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes ("short contact therapy") to avoid skin irritation, which is not needed for the drug to work. When it works, new hair growth is usually evident in 8 to 12 weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.
- Topical sensitizers - Medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in 3 to 12 months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.
Drugs that affect the immune system include:
- Sulfasalazine - A sulfa drug, sulfasalazine has been used as a treatment for different autoimmune disorders, including psoriasis. It acts on the immune system and has been used to some effect in patients with severe alopecia areata.
- Oral Cyclosporine - Originally developed to keep people's immune systems from rejecting transplanted organs, oral cyclosporine is sometimes used to suppress the immune system response in psoriasis and other immune-mediated skin conditions. But suppressing the immune system can also cause problems, including an increased risk of serious infection and possibly skin cancer. Although oral cyclosporine may regrow hair in alopecia areata, it does not turn the disease off. Most doctors feel the dangers of the drug outweigh its benefits for alopecia areata.
Photochemotherapy:
In photochemotherapy, a treatment used most commonly for psoriasis, a person is given a drug called a psoralen, which is affected by light. The drug can be swallowed or rubbed on the skin. Once the drug is taken or applied, the area with hair loss is exposed to an ultraviolet light source. This combined treatment is called PUVA. In clinical trials, approximately 55 percent of people achieve cosmetically acceptable hair growth using photochemotherapy. However, the relapse rate is high, and patients must go to a treatment center where the equipment is available at least two to three times per week. Furthermore, the treatment carries the risk of developing skin cancer.
Alternative therapies:
Some people with alopecia areata try other treatments. These alternatives include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Because many alternative therapies have not been studied in clinical trials, they may or may not help hair grow back. In fact, some may cause more hair loss. Just because these therapies are natural does not mean that they are safe. Talk with your doctor before you try alternative therapies.
How Will Alopecia Areata Affect My Life?
Alopecia areata does not make you feel pain and does not make you feel sick. You can't give it to others. People who have the disease are, for the most part, healthy in other ways. Alopecia areata will not shorten your life, and it should not affect activities such as going to school, working, marrying, raising a family, playing sports, and exercising.
Can I Pass It on to My Children?
It is possible, but not likely, for alopecia areata to be inherited. Most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which a child has a 50-50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55 percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.
To learn more about the genes and other factors involved in alopecia areata risk, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is funding an alopecia areata registry. The registry is an organized network of five centers throughout the United States that will identify and register patients with the disease and collect data and blood samples (which contain genes). Data, including genetic information, will be made available to researchers studying the genetic basis and other aspects of disease and disease risk. For more information about the registry, see "How Can I Take Part In Research?" listed below.
How Can I Cope With the Effects of This Disease?
Living with hair loss can be hard. There are many things you can do to cope with the effects of this disease, including:
- Learning as much as you can about the disease
- Talking with others who are dealing with the disease
- Learning to value yourself for who you are, not for how much hair you have or don't have
- Talking with a counselor, if necessary, to help build a positive self-image
Here are some things you can use to reduce the physical dangers or discomforts of lost hair:
- Use sunscreens for the scalp, face, and all exposed skin
- Wear eyeglasses (or sunglasses) to protect eyes from sun, and from dust and debris, when eyebrows or eyelashes are missing
- Wear wigs, caps, or scarves to protect the scalp from the sun and keep the head warm
- Apply antibiotic ointment inside the nostrils to help keep germs out of the nose when nostril hair is missing
Here are some things you can do to reduce the disease's effects on your looks:
- Try wearing a wig, hairpiece, scarf, or cap
- Use a hair-colored powder, cream, or crayon applied to the scalp for small patches of hair loss to make the hair loss less obvious
- Use an eyebrow pencil to mask missing eyebrows
What Research Is Being Done on Alopecia Areata?
Researchers are seeking a better understanding of the disease. Scientists are studying:
- Genes
- Hair follicle development
- The immune system
- Drugs and treatments for other autoimmune diseases like rheumatoid arthritis and lupus
- Better ways to get drugs directly to the hair follicles
- Stem cells in the skin
How Can I Take Part in Research?
A good place to start is the National Alopecia Areata Registry sponsored by the NIAMS.
The registry, a network of five centers, will identify and register patients with the disease and collect information and blood samples (containing genes). Data, including genetic information, will be made available to researchers studying the genetic basis and other aspects of the disease and disease risk.
The registry is seeking U.S. residents with alopecia areata, alopecia totalis, or alopecia universalis diagnosed by a dermatologist. Although the registry itself will not be involved in any kind of treatment for alopecia areata, people who register will be made aware of studies for which they may qualify.
To take part in the registry, people don't have to live near or travel to one of the five centers; however, they do have to meet some requirements to participate. For more information, log onto the registry website at
- www.AlopeciaAreataRegistry.org
or have your doctor contact:
Madeline Duvic, M.D., Principal Investigator
Department of Dermatology
M.D. Anderson Cancer Center
1515 Holcombe Boulevard, Box 434
Houston, Texas 77030
Phone: 713-792-5999
Fax: 713-794-1491
E-mail: alopeciaregistry@mdanderson.org
For More Information About Alopecia Areata:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: http://www.niams.nih.gov
National Center for Complementary and Alternative Medicine
National Institutes of Health
P.O. Box 7923
Gaithersburg, Maryland 20898
Phone: 301-519-3153
Toll Free: 888-644-6226
TTY: 866-464-3615
Fax: 866-464-3616
Email: info@nccam.nih.gov
Website: http://nccam.nih.gov
American Academy of Dermatology (AAD)
P.O. Box 4014
Schaumberg, Illinois 60168-4014
Phone: 847-330-0230
Toll Free: 888-462-3376
Fax: 847-330-0050
Website: http://www.aad.org
National Alopecia Areata Foundation (NAAF)
14 Mitchell Blvd.
San Rafael, California 94903
Phone: 415-472-3780
Fax: 415-472-5343
Email: info@naaf.org
Website: http://www.naaf.org
American Hair Loss Council
125 Seventh Street, Suite 625
Pittsburgh, Pennsylvania 15222
Phone: 412-765-3666
Fax: 412-765-3669
Website: http://www.ahlc.org
References:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health
September 2005
www.niams.nih.gov
This summary does not include everything there is to know about the medicine mentioned above. Do not use this medicine without first talking to your doctor. Other brand names or generic forms of this medicine may also be available. Side effects other than those listed may occur. This medicine may be prescribed for other uses. If you have questions or concerns, or want more information, your doctor or pharmacist has the complete prescribing information about this medicine and possible drug interactions. For updates or questions about any medications, contact the United States Food and Drug Administration toll free at 1-888-INFO-FDA (463-6332), or visit www.fda.gov. or consult your doctor for more information.