Alopecia areata (AA) is a non-scarring, inflammatory, hair loss disease that is seen in men, women and children. It 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).
Although great progress has been made in the research of hair diseases, the exact etiology of alopecia areata is still to be established. However, there is a lot of evidence to support the fact that alopecia areata is a multi-entity disorder with causes that are multifactorial, including evident autoimmune and genetic components. The disease presents with the loss of scalp and body hair by interruption of their synthesis. There is no destruction or atrophy of the follicles, and therefore the hair loss can be reversible.
Normally, hair growth in each hair follicle occurs in a cycle. There are three main phases of the hair growth cycle anagen (active growth phase), catagen (period of controlled regression) and telogen (resting state in the hair follicle cycle). Alopecia areata primarily affects the hair follicle as it enters the anagen phase, and studies further indicate that the initial event in the development of alopecia areata is the premature precipitation of anagen follicles into the telogen state or resting state of the hair follicle cycle.
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.
When you suffer from alopecia areata, it is unfortunate that no one is able to answer the question, “Will my hair grow back?” We just don’t know. In some cases, where there are small patches, and they’ve appeared quite suddenly and remained small, regrowth is quite often spontaneous. If they begin to spread, the greater the area that is covered, the less chance of recovery, is the general rule, but not always. There are cases where people have lost their hair for over 20 years with alopecia areata who, for some reason which nobody understands – science certainly doesn’t – suddenly the hair regrows.
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