Alopecia Areata: Symptoms, Diagnosis, Treatment

Alopecia areata is a condition that occurs when your immune system attacks hair follicles and leads to hair loss. Hair follicles are the structures in the skin responsible for forming hair. Although hair can fall from any body part, alopecia areata typically affects the head and face.

Alopecia areata causes hair to usually fall out in tiny, circle patches around the size of a quarter, but hair loss is more extensive in certain cases.

Around one in 50 people will develop alopecia areata at any time in their life. This condition does not discriminate as it happens in males and females of all races equally. Alopecia areata can occur at any age, although most individuals have alopecia areata for the first time before they turn 30. Most individuals with the disease are generally healthy and do not have other symptoms.

What are the symptoms of alopecia areata?

Most individuals who have alopecia are healthy and have no other symptoms to disrupt their lives. However, this condition varies from person to person. Some individuals experience hair loss throughout their whole lives, but some individuals only experience an episode of it.

1. Patchy hair loss or sudden loss of hair in round or oval patches on the scalp. Patches can also occur on other areas of the body, such as the beard, eyebrows, eyelashes, and other body hair.
2. The skin in the affected areas (bald patches) is usually smooth and without any scarring or signs of inflammation.
3. Short, broken hairs at the edges of bald patches become narrower at the base, resembling an exclamation mark.
4. Some individuals may experience a tingling, itching, or burning sensation on the scalp or other affected areas before hair loss occurs.
5. In some cases, hair loss can be more diffuse, leading to thinning across the scalp rather than distinct patches.
6. Hair may regrow in the affected areas, only to fall out again later. This cycle of hair loss and regrowth can continue over time.

What are the causes?

In cases of alopecia areata, the immune system mistakenly attacks hair follicles, resulting in inflammation. While researchers do not completely understand the precise cause of the immune attack on hair follicles, they believe that a combination of genetic and environmental factors may play a role in this.

What are the risk factors?

Around 20 percent of individuals with alopecia areata have a family member who is also impacted by this condition.

According to this information, experts believe that certain individuals have a genetic predisposition to the condition. A person who has a close relative with alopecia areata has a slightly elevated risk of developing it too. The risk further increases if the family member experiences hair loss before the age of 30.

How is alopecia areata diagnosed?

Diagnosing alopecia areata typically involves a combination of medical history review, physical examination, and sometimes additional tests to rule out other potential causes of hair loss.

• Pull test: During a pull test, the doctor gently tugs on a small amount of hair to see how many hairs come out. In alopecia areata, this test may reveal easily detachable hairs from the borders of bald patches.
• Skin biopsy: In some cases, a skin biopsy may be performed to confirm the diagnosis and rule out other conditions that can cause hair loss. A small sample of skin from the affected area is removed and examined under a microscope.
• Blood tests: While not always necessary, blood tests may be ordered to check for underlying medical conditions that could contribute to hair loss, such as thyroid disorders or autoimmune diseases.

How is it treated?

There is no cure for alopecia, however, there are several treatment options for alopecia.

1. Topical treatments

   • Corticosteroids are applied directly to the bald patches to reduce inflammation and suppress the immune system. This topical application can include creams, ointments, lotions, or foams.
   • Minoxidil (Rogaine) is applied to the scalp to stimulate hair growth. It can be used alone or in combination with other treatments.
   • Topical immunotherapy is done by applying a substance that causes an allergic reaction to the spot of hair loss. However, the reasons for hair growth are not fully understood.

2. Intralesional corticosteroid injections

   • These are injections of corticosteroids directly into the bald patches.
   • It is one of the most common and effective treatments for small patches of alopecia areata.

3. Oral treatments

   • Oral corticosteroids can be taken to suppress the immune system. It is typically used for more severe or widespread cases.
   • Immunosuppressive drugs such as methotrexate or cyclosporine can be used to suppress the immune system in more severe cases.

4. Phototherapy

   • Phototherapy is a beneficial therapeutic approach for various skin conditions due to its ability to modulate the cutaneous immune system.

How to cope with alopecia areata with self-care?

Although this condition does not cause physically disability, it may impact and individual’s well-being. There are various self-care methods to cope with the impacts of this condition.

• Educate yourself and chat with others who are dealing with similar experiences. Building a support network can help you go through difficult times.
• Talk a mental health professional for psychological support.
• Use sunscreens for any bare areas.
• Wear wigs, hairpieces, hats, or scarves to protect your scalp from the sun.
• If you have lost hair from your eyebrows or eyelashes, wear sunglasses to protect your eyes.

Make an appointment at Pantai Hospitals

Consult your doctor if your alopecia symptoms worsen or if you notice new symptoms. A dedicated and expert team of dermatologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.