Alopecia areata – causes, symptoms, diagnosis and treatment [EXPLAINED]

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Alopecia areata is a disease in which the hair follicles are damaged, resulting in hair loss. This disease affects people of all ages, but it is much more common in people under 30 years of age. What is alopecia areata, what are its causes and how does it manifest itself? What doctor to go to for advice in the case of suspected alopecia areata?

1. Alopecia areata is a disease of young people. Women and men get sick as often
2. The most characteristic symptom is bald patches on the head
3. It is not known what exactly causes alopecia areata. Experts believe the cause may be autoimmune
4. You can find more such stories on the TvoiLokony home page

Alopecia areata usually occurs in young people under 30 years of age. The course and progression of alopecia areata can lead to complete loss of scalp hair, eyebrows, eyelashes or pubic hair. Severe cases of alopecia areata are also characterized by nail changes of various severity and morphology. Such disease progression is often the cause of serious psychological disorders caused by the lack of acceptance for the development of the disease and the lack of acceptance of one’s own appearance.

In alopecia areata, the hair follicles are attacked and destroyed, causing the hair to fall out and the skin to form bald patches. Alopecia areata is very rarely associated with specific internal or external health problems. Despite this, specialists indicate many diseases and external and internal activities that may significantly increase the risk of alopecia areata. Interestingly, it often happens that the bald spots become overgrown with hair on their own.

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Alopecia areata and proper hair growth

Genes are responsible for the growth rate and density of our hair. Human hair does not grow continuously, and the hair growth cycle itself is divided into three phases:

1. the growth phase, or anagen – this phase is considered to be the most important in the hair growth cycle. It is also called the active phase of hair growth. In fact, as much as 85-90 percent. the hair on the human head is in the anagen phase. Anagen is the period when the hair is permanently connected to the hair follicle, thanks to which it is properly nourished and its length increases. It can be assumed that in a healthy person the anagen phase lasts about 6 years;
2. transition phase or phase of involution, or catagen – in the second phase, the hair separates from the hair follicles, which begins the process of their dying off. During this period, the hair bulb contracts and the hair emerges from the follicle. 1-3 percent is in the catagen phase. hair on the head. The process of dying off hair takes about 3 weeks;
3. the resting phase, or telogen – this is the last phase in which the hair follicle is at rest. This is the period when no new hair grows because the hair follicles are empty. The telogen period can last up to several months. Experts say that about 8-15 percent are in the telogen phase. hair on our head. 

The three presented phases occur with a normal hair growth cycle. In case of alopecia areata is a shortened hair growth cyclewhich means premature start of the catagen phase. In alopecia areata, the hair follicles that produce pigment are attacked by the inflammatory cells, creating an infiltrate. The inflammatory infiltrate consists of lymphocytes, dendritic cells and mast cells.

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Alopecia areata – types

Alopecia areata is a disease that can occur in many different ways. The most common types of alopecia areata include:

1. multifocal alopecia areata – means the presence of a clearly delineated, round bald spot in more than one place;
2. total alopecia areata – means loss of hair from the entire scalp;
3. focal alopecia areata -means the presence of alopecia in one part of the body; 
4. generalized alopecia areata – indicates the occurrence of alopecia on the entire scalp, i.e. also the eyebrows, eyelashes, hair and armpit; 
5. malignant alopecia areata – means baldness in which the hair does not grow back. It is the result of a refractory response to long-term treatment;
6. serpentine alopecia areata, also called peripheral alopecia – means alopecia in which the bald parts form a band around the head, occupying the occipital, frontal and temporal areas;
7. streaked alopecia areata – means baldness, in which the hair decreases from the center of the head to the outside;
8. diffuse alopecia areata – means baldness, in which individual lesions cannot be distinguished. 

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Types of alopecia areata

Alopecia areata is very often characterized by a long and often long duration of the disease. One of the divisions of alopecia areata is the Ikeda classification. Due to the prognostic aspect, this division suggests four types of alopecia areata:

1. the common type of alopecia areata – it is characterized by a very rapid onset and spontaneous recovery of changes;
2. atopic type of alopecia areata – this is a less promising type of baldness, which is usually extensive. The occurrence of alopecia is related to the presence of atopic skin diseases in the patient;
3. type of alopecia areata combined – it is a type of alopecia occurring in people with AA (aplastic anemia) with concomitant disorders of endocrine organs, including, for example, the thyroid gland;
4. type of alopecia areata hypertonic – the type of alopecia, in which the lesions may merge into a larger whole, is associated with a tendency to develop arterial hypertension. 

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Alopecia areata – causes

Alopecia areata is a condition that affects about 2 percent of people. patients who consult a dermatologist. Specialists report that men and women struggle with alopecia areata as often. The onset of the disease usually occurs in childhood or young age and can occur at any time in life.

The causes of alopecia areata have not been fully investigated. However, it is widely believed that autoimmune factors play a direct role in its occurrence. This means that for people diagnosed with alopecia areata, the immune system attacks the hair follicles as it treats them as ‘foreign’. An attack of the immune system causes inflammatory changes, which contributes to damage to the hair follicles and hair loss.

The inflammatory changes that occur in the hair follicle are the main cause that starts the disease. Keratinocytes release inflammatory cytokines which in turn activate endothelial cells. This causes inflammatory cells to accumulate around the hair follicle, which further intensify the inflammatory process. The stronger the infiltrate turns out to be, the greater the damage to the hair follicle will be. Inflammation accelerates the transition of the hair to the telogen phase, which results in gradual hair loss. Once the inflammation has subsided, the hair follicles resume their action, so hair loss is reversible.

Factors that are taken into account in determining the causes of inflammation in hair follicles include: atopy, genetic factors, factors of hormonal disorders, factors of mental disorders, intracorporeal foci of infection, long-term stress and autoimmune phenomena.

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Alopecia areata outbreaks they are usually regular in shape, hairless, and the skin remains unchanged. Changes in alopecia areata are usually located in the occipital and fronto-parietal areas. However, it can be estimated that about 14-25 percent. sick, loses hair from the entire area of ​​the head.

Describing symptoms of alopecia areata, it is worth noting that although it is an inflammatory disease, no symptoms typical of inflammation, such as erythema, are noted. In some cases, patients complain of itchy skin, and the altered tissue around the nails is much less common.

Unfortunately, but based on current medical knowledge, it is not possible to identify symptoms that would precede the appearance of alopecia areata.

What to do when hair falls out? Check it out: How to stop excessive hair loss?

The trichologist deals with a thorough analysis of the condition of the scalp, hair bulbs and any diseases related to the scalp. In many cases, a trichologist may be a specialist in the treatment of alopecia areata.

What tests can be performed to diagnose the condition of the hair? Check: Trichological examination – treatments and prices

Diagnosis of alopecia areata

The correct diagnosis of alopecia areata is made on the basis of an interview and various specialist tests performed by a doctor. A patient who consults a specialist should be prepared for several characteristic examinations. The diagnosis of alopecia areata may include:

1. family history with the patient – during the medical interview, the doctor will ask the patient about diseases in the family. It turns out that atopy, thyroid disease or other autoimmune diseases may be associated with alopecia areata;
2. physical examination of hair, skin, nails and eyes – in an office examination, the doctor examines hairless foci or large areas of alopecia with normal-looking skin. On the other hand, in the case of nail changes, a dermatologist most often diagnoses pimples, less often –ychodystrophy. Additionally, clouding of the lens is observed among the eye ailments; 
3. dermoscopy – this test allows the observation of the structures located within the epidermis, the upper layers of the dermis, the hair follicle outlets, the skin surrounding the follicle, microcirculation vessels and hair at high magnification. In some cases, additional examination of the hair of eyebrows or eyelashes and other hair provides information important in the diagnosis of alopecia areata; 
4. pull test – this test measures the activity of the disease and involves pulling 40-60 hair tufts in three different places on the scalp. A positive result is obtained when more than 10 hairs or more than three hairs are pulled at each location;
5. laboratory tests – in the diagnosis of alopecia areata, functional tests of the thyroid gland or the assessment of anti-thyroid antibodies may be indicated. It is worth noting, however, that no laboratory test is a direct indication for a diagnosis of alopecia areata; 
6. histological examination – in doubtful cases, the doctor may decide to take a sample from the lesion. Histological examination of acute alopecia areata shows a dense lymphocytic infiltrate around the bulb.

If you want to know more about dermatoscopy, read: Dermatoscopy – what is it and when is it performed?

Alopecia areata – treatment

The treatment of alopecia areata is based on local and general treatment. Due to the fact that the cause of alopecia areata has not been fully understood, none of the proposed treatments has been determined to be fully effective. For the local treatment of alopecia areata, intradermal glucocorticosteroids, topical glucocorticosteroids in the form of creams, gels, ointments, lotions and foams, cygnoline, and minoxidil are used. In general treatment, glucocorticosteroids and cyclosporine are used. In some cases of alopecia areata treatment, photochemotherapy (PUVA or PUVA-turban) and narrowband UVB phototherapy are also used.

In the treatment of alopecia areata, you can also use:

1. mesotherapy – is a group of treatments that involve the intradermal or subcutaneous administration of appropriate nutritional cocktails. Needle, micro-needle and needle-free mesotherapy can be distinguished; 
2. carboxytherapy – this procedure consists in the intradermal or subcutaneous administration of carbon dioxide. Thanks to the treatment, blood vessels dilate and new ones are formed;
3. cryomassage – is a procedure that involves the administration of nitrous oxide, which results in a significant cooling of the tissues. Performing the treatment stimulates biological regeneration of the hair follicles.

More information about mesotherapy can be found here: Needle mesotherapy – medicine for the skin

Home remedies for alopecia areata

As already mentioned, the treatment of alopecia areata is usually not fully effective. However, there are methods that are helpful in stimulating hair growth. For example, supporters of natural medicine who treat alopecia areata with scalp massage assisted with injections offer their help.

Onion juice also turns out to be helpful in stimulating hair growth. To make such a juice, just cut the onion into slices and blend it. Before applying the mixture on the scalp, warm the juice to room temperature. The procedure should be performed twice a day for about two weeks.

At home, you can also support the treatment of alopecia areata with herbal mixtures or aloe. However, it should be remembered that in most cases such masks are definitely not enough and should always be accompanied by professional treatment.

If you want to make homemade hair masks, see the recipes: Homemade hair masks – recipes

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In 10% of patients, alopecia areata may be more severe and, consequently, lead to total baldness. A much worse prognosis of the disease concerns people who are struggling with autoimmune diseases.