What is Alopecia Areata? Causes, Types, Treatment of Alopecia

While brushing or combing hairs do you find more hairs in your hair brush than normal? Or Do you find more hairs in the sink after Shampooing your hairs or while styling them? Or Do you find wider parting/ thinning of the crown?
If your answer to the above questions is yes, then beware, folks, these may be the signs of alopecia areata.

What is Alopecia?

Alopecia Hair loss or baldness is a very common problem. Alopecia is a general term used to define hair loss either from the head or any other body part where there is normal hair growth. However, this condition typically affects the head. Nowadays this problem is not just confined to old people but also affects both young adults, and middle-aged. It often first appears during childhood and was different for everyone who has it. Today alopecia areata has become a major cause of psychological distress.

Hair loss may be of many types as the pattern and degree of hair loss varies. Normally we have approximately 1 lakh to 1.5 lakh hair strands of hair on the head. On an average, the number of hair strand lost every day is 100. To maintain a normal hair count, the hairs should be replaced just the same way as they are lost. But if this balance is not maintained it results into baldness. One point to understand is that the breaking of the hair shaft and hair loss caused due to a decrease in the hair growth is two different things. To understand hair fall, let us learn a little detail about the pathophysiology of hair growth cycle.

Hair Growth stages

There are 3 stages of hair growth

1. Long growing stage (anagen): This stage lasts between 3&5 years and the growth of hairs is 1cm per month

2. Short transitional stage (catagen): This stage remains for about 2 weeks.

3. Short resting stage (telogen): This is a dormant phase that lasts for approximately 3 months. There is no hair growth during this phase.

As the resting stage ends the hair falls, and there is a growth of new hair from that follicle. In a normal case about forty hairs reach the resting phase and they will fall out. If this limit crosses more than 100 per day, then there is a clinical loss of hairs and the person should consult with the physician. But exceptionally, some people can have Telogen phase as predominant so they can lose many hairs that can cause anxiety but it doesn’t cause baldness.

Types of Alopecia

When a person has a medical condition called alopecia areata, the hair falls out in round patches. Initially, it starts with one or more small, round, and smooth patches. There are many types of Alopecia. With each of these Alopecia types, you or someone you care about may experience slightly different symptoms. The treatment of alopecia is also different for each type. Listed below are the types of Alopecia.

1. Male Pattern Baldness (Androgenic Alopecia of males)

This type of Alopecia is most common. About half of the men above 50 years of the age will suffer from this type. It may start in early 20’s or 30’s. Androgenic alopecia may affect both male and female, but it is more dramatic in the case of men. It is characterized by a pattern of a receding hairline and includes a central and bitemporal recession. This leads to horseshoe shape of the remnant of hairs around the sides and back of the head. Rarely, it leads to complete hair loss. Male pattern baldness runs in the family and is considered to be caused due to oversensitive hair follicles. However, it is also considered to be linked to the high amount of male hormones and thus it is also known as androgenic alopecia of the males.

2. Female Pattern Baldness (Androgenic Alopecia of females)

Androgenic alopecia can also affect females but the cause is unclear. However, as compared to males the hair loss is more diffuse and generally, scalp’s top part is affected. It can increase in the women who were at menopause stage. Evidence also show some ethnic variations.

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3. Alopecia Areata

It is caused due to an autoimmune disorder. This condition is commonly observed in the patients suffering from other autoimmune diseases such as diabetes, overactive thyroid, and Down’s syndrome. Although this condition can affect people of any age group, but it is more common in the age group between 15-29 years. It is estimated that every 1 person in 1000 suffers are from Alopicia Areta. Hair often grows back but may fall out again. Sometimes the hair loss lasts for many years. In most of the cases, this condition solves on its own.

The more severe forms of this type are

Alopecia Totalis– This involves total Hair loss of the scalp.
Alopecia Universalis– It involves total hair loss of the full body.

4. Telogen Effluvium

With this type of hair loss, the hairs go to the Telogen phase. It is a non-scarring type of alpecia that is characterized by acute and diffuse shedding of the hair. In some cases, the chronic form of telogen effluvium may also occur where the onset is insidious and lasts for a long duration. This condition arises due to hormonal, metabolic stress and certain medications such as beta-blockers, medicines of high blood pressure and anticoagulants. Most commonly this condition follows pregnancy. Usually, after 6 months the hair fall stops and hair begins to grow again.

5. Scarring Alopecia

It is also known as cicatricial alopecia. Scarring Alopecia is a complication of other conditions. This type of alopecia results in the destruction of the hair follicles and thus your hair does not grow back. Some of the common scarring alopecia causes are scleroderma, lichen planus, and discoid lupus. Scarring alopecia can affect anyone of any age group but is less common in children.

6. Trichotillomania

Hair loss due to Trichotillomania is caused due to compulsive bending or pulling of hairs. This disorder begins at the onset of puberty and continues throughout the adulthood. It may lead to permanent hair loss due to constant pulling of hairs.

7. Traction Alopecia

Here alopecia is caused due to the rigorous brushing of hair and heat styling. People who make ponytails or cornrows hairs with an excess force causes pulling of hairs thereby causing Traction Alopecia. This weakens individual hair strands and also break off leading to a reduction in hair volume.

8. Anagen effluvium

This type is a widespread loss of hair and affects not only scalp but also body and face. A common cause of Anagen effluvium is chemotherapy. However, not all chemotherapy drugs cause hair loss. Other cancer treatments such as radiotherapy and immunotherapy also cause loss of hair. Within weeks of the beginning of the treatment, the hair loss becomes noticeable. In most of the cases, loss of hair due to Anagen effluvium is temporary and in a few months hair begins to grow again.

Other rare forms of alpecia are folliculitis decalvans and frontal fibrosing alopecia.

Symptoms of Alopecia

The most prominent Alopecia symptoms are Hair loss in patches. A few people may also feel a burning sensation or itching. The Common symptoms of alopecia include

Loss of hairs commonly in circular form
Dandruff
Skin lesions
Scarring

Some of the characteristic symptoms of Alopecia areata include loss of hairs in unusual areas, e.g. Eyebrows, above the ears, head’s backside. The male pattern baldness symptoms include thinning and loss of hairs begins at the crown and temples, leaving a horseshoe pattern of baldness. Whereas the characteristic symptoms of female pattern baldness include Hair loss occurring at the parietal and the frontal region.

Read more: Home remedies to treat Hair fall

Alopecia areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are some small changes that can occur to nails such as Pinpoint dents in your fingernails, White spots and lines, roughness of nails, lose their shine, Thin and Split nails, etc.

What are the causes of Alopecia ?

There are plenty of factors that contribute to developing this complex condition. But the exact cause of alopecia areata is unknown. About 1 in 5 people with this condition have a family history. Alpecia may be caused due to certain skin conditions, systemic illness, hormonal imbalance and certain medications. The common Alopecia causes are listed below.

Allopecia Causes

Malnutrition.
Iron deficiency.
HIV/AIDS.
Lupus erythematosus.
Hormonal imbalance.
Fungal infections.
Sarcoidosis.
Radiation and chemotherapy.
High level of male hormones.
Genetics.
Infections such as folliculitis, dissecting cellulitis, Secondary syphilis and fungal infection (tinea capitis).
Demodex Folliculorum: It is a very small mite that can be found on the scalp that is excessively oily. These mites consume the sebum (a secretion of sebaceous glands) due to which hairs do not get the essential nutrients and thus, results in thinning of hairs and hair fall.
Drugs: Such as medications for high blood pressure, heart disease, diabetes, and cholesterol or any other drugs that change the body’s hormonal balance such as acne medications, steroid, contraceptive pills.
Trauma: Caused due to radiations and major surgery.
Childbirth and pregnancy.
Poisoning, Severe stress, Environmental toxins, and pollution.
Styling and other chemical loaded hair products.
An excessive quantity of sebum production that blocks the hair follicle and leads to their deterioration, damage the hair cuticle and restrict the hair growth.

Diagnosis of Alopecia

Your doctor will examine your symptoms to determine if you have alopecia areata. If your doctor suspects you suffering from alopecia he may ask you to have following tests:

1. Pull test

It is used to diagnose diffuse scalp baldness. In this test about 40 to 60 hairs are taken from 3 different scalp areas and then a light traction is applied. After this, the extracted hairs are counted and they are seen under a microscope. In the normal case, less than 3 hairs per area should come each time the hairs are pulled.

2. Pluck test

Under this test, the hairs are pulled from their roots and the roots are seen in a microscope to see the stages of growth. By microscopic examination defects in Anagen, Telogen or any systemic disease can be judged. Under the roots of Telogen hairs, the tiny pulp is present without sheets. In Anagen hairs, sheets are present in their roots. In Anagen effluvium, there is a decrease of Telogen stage hairs.

3. Biopsy of scalp

The Biopsy is done to differentiate between nonscarring and scarring forms. The hair samples are usually taken from the inflamed area, i.e. from the peripheral area of the hair loss patch.

4. Daily hair counts

This is done by collecting hairs while combing in the morning/ during washing and then they are counted. This is done for 14 days. If the count is greater than 100 per day, then it is treated as abnormal.

5. Trichoscopy

It is done by using a handheld dermoscopy.

6. Savin scale and Ludwig scale

It helps to detect female pattern baldness.

7. Hamilton scale and Norwood scale

It helps to detect male pattern baldness.

Your doctor may also ask you questions related to family history of alopecia, any previous infection and or any medications if taking. Besides the above tests, blood tests may also be done to identify any disease condition if present.

Management of Alopecia

Your doctor may prescribe you certain Alopecia medications such as Minoxidil, Dutasteride, and Finasteride. These medications are usually used to prevent male pattern baldness.

Minoxidil

It is in liquid/ foam form and is applied to the scalp 2 times daily. Minoxidil is more effective when used in early stages of hair loss and is less effective for long-term hair loss. It should be used for 6 months to obtain the desired results. In fact, its use should be continued to maintain the hair growth later on. But the side effects of minoxidil are scalp irritation, allergic dermatitis, unwanted hairs.

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Finasteride

It is consumed as a pill. The recommended dose is 1mg/day. It should not be used for females. The results usually appear within six weeks after beginning the treatment. It’s Side effects are low sex drive, ejaculation dysfunction, erectile dysfunction. Recurrence of Hair fall occurs when the treatment is stopped.

Injectables

Corticosteroids are used to cure Alopecia areata and it is injected monthly. Immunosuppressants are used in case of Allopecia Areata. But the use of Immunosuppressants has significant side effects.

Other than above medications Anthralin may be used to cure Alopecia areata. The hormonal modulator can also be used to cure female pattern baldness.

Alopecia Treatment

How is Allopecia Treated ? Unfortunately, there is currently no cure for alopeciaareata, although there are some forms of treatment that can be suggested by doctors to help hair regrow more quickly. Depending on which type of alopecia areata you or your child has, your age, and the extent of hair loss, there are a variety of areata alopecia treatments available for disrupting or distracting the immune attack and/or stimulating the hair follicle.

Hair transplantation

Hair transplantation usually takes 4-8 hours and is done in several sessions. The surgeon takes the hairs from the patient’s sides and back of the head and transplants them into the bald area. Hairs that are transplanted initially falls out within some weeks, but after a few months, there is a permanent regrowth of the hairs.

Surgery

There are various surgical options to treat alopesia such as:

Scalp flaps.
Hair loss reduction.
Follicle transplants.

The procedures for treating the disease are done according to the patient’s choice. Also, the above procedures are quite painful and expensive.

Scalp reduction– It is done in combination along with hair implantation so that the hairline will look natural.
Hairline lowering– It is used to bring down high hairline, but it may lead to scar formation.

There are some useful steps to minimize discomfort such as

Wigs can also be used by patients for esthetics.
Wearing sunglasses to protect the eyes from sun and dust if the eyelashes have fallen out.
Applying sunscreen to preserve exposed areas from sunburns.
Hair restyling i.e. “combing over” covering the bald area with left over hairs by combing them towards the bald area can also be done.

To prevent or lower baldness associated with chemotherapy hypothermia caps can be used, but only in certain types of chemotherapy.

Embracing baldness- People can shave their head as a shaved head can grow stubble just like a shaved face. But for females, this is less socially acceptable.

Treatment of hair loss in eyebrows

Hair loss in Eyebrows is caused by hormonal imbalance, autoimmunity, and chemotherapy. Usually, outer 1/3rd of the eyebrow is lost in hypothyroidism. Treatment includes the use of artificial eyebrows. Eyebrow Embroidery can be used. Micropigmentation (tattooing) is also used in case of eyebrow loss. Also, check the types of treatment of Alopecia that we have in these days.

Diet to Prevent Alopecia

There are several food options that to some extent prevent and can control alopesia. So, include whole grains, beans, seeds, nuts, foods high in calcium, such as tofu, nuts, nut milk, soy products, soy milk and green leafy vegetables. Better to switch on to healthy fats that are rich in omega-3 fatty acids such as olive oil, canola oil, walnuts, flax seed and hemp seed. Other sources of Omega-3 fatty acids are mackerel, trout, tuna, sardines, and salmon. Include Fresh fruits and vegetables or juices that are rich in antioxidants and vitamin B rich foods, like nuts, carrots, chard, romaine lettuce and tomatoes are also found helpful.

How to Prevent Alopicia

If your shrinking hairline and bald spots are giving you sleepless nights, here are a few dietary modifications and tips to help keep your hair and its shine last long.

Besides including the above-mentioned food in your diet better avoid alcohol, processed, and fatty foods, refined sugars.
Limit the intake of animal meat and quit smoking.
Since stress is a major trigger, do some exercises, meditation, and other stress-relief therapies to prevent hair loss.
Limit the use of hair dryers.
Cut down on dyes and chemicals. So, never color your hair more regularly than every four to six weeks.
Don’t bleach or pull your hair too tight.

People with hair loss should be supported by their friends and family members. They can also approach a counselor to get help psychologically. The best treatment for any type of hair loss such as Alopecia is to leave it untreated and social acceptance.