Alopecia areata, also referred to as spot baldness, is an autoimmune disease that affects approximately 6.8 million people in the United States and 147 million worldwide. The most prominent characteristic of alopecia areata is patchy hair loss on the scalp. In most cases of alopecia areata, hair loss occurs in small, round patches that are no larger than a few centimeters in diameter.
There’s no cure for alopecia areata, but most people are able to fully recover, although the duration of the disease varies greatly—from months to years. Some people require treatment, but others are able to regrow their hair without any medical intervention.
Alopecia Areata Causes
Researchers agree that autoimmune disease is the underlying cause of alopecia areata, although the exact mechanism is still unknown. The condition tends to develop in people who have a family history of other autoimmune disorders, such as type 1 diabetes, thyroid disease, or rheumatoid arthritis, which leads researchers to speculate that genetics play a fairly significant role in the development of the condition.
But genetics aren't the only culprit, and they certainly don't act alone. Research suggests exposure to certain environmental factors triggers the onset of the disease in people who are genetically predisposed. However, the exact environmental factors that prompt the disease to turn on remain unknown.
What Is an Autoimmune Disease?
The immune system is the body’s first line of defense against disease and infection. The immune system recognizes pathogens like bacteria and viruses as foreign invaders and sends out proteins called antibodies to attack and destroy them. The destruction of these pathogens protects the body from disease and illness.
An autoimmune disease develops as a result of a dysfunctional immune system. In autoimmune disease, the immune system falsely flags healthy cells, tissues, and organs as foreign invaders. It then sends out antibodies to attack these healthy structures. This ongoing attack destroys the cells, tissues, and organs, and the result is some type of autoimmune disorder and, in most cases, chronic symptoms.
Because autoimmune diseases can affect any part of the body, they can cause a wide array of symptoms. More than 80 autoimmune diseases have already been identified and there are even more in question. The National Institute of Environmental Health Sciences calls autoimmune diseases one of the most prevalent diseases in the United States, affecting almost 24 million Americans.
Some of the most common and well-known autoimmune diseases include:
- Type 1 diabetes
- Multiple sclerosis
- Rheumatoid arthritis
- Celiac disease
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
Although alopecia areata is not one of the most common autoimmune diseases, it still affects a significant amount of the population and the emotional toll can be devastating for some.
Alopecia Areata Symptoms
Bald patches on the scalp is the most common alopecia areata symptom. Hair loss typically happens in a short period of time and only presents on one side of the scalp. In most cases, hair loss occurs in a round or oval pattern and doesn’t exceed a couple centimeters in diameter.
Most patients with alopecia areata first become aware of the disease when they notice clumps of hair coming out in the shower or on their pillow when they wake up first thing in the morning.
Unlike other types of alopecia, alopecia areata doesn’t result in total hair loss and usually doesn’t affect any areas beyond the scalp. The other types of alopecia include:
- Alopecia totalis – complete loss of hair on the scalp
- Alopecia universalis – complete loss of scalp hair and body hair
In addition to hair loss, other symptoms of alopecia areata include dents or ridges in the fingernails, referred to as “stippling” or “pitting.”
Alopecia Areata Treatment
Although there is currently no cure for alopecia areata, there are several different treatment options available depending on the percentage of hair loss. Those with more than 50% hair loss on the scalp may be given oral or injectable medications, such as steroid injections, while those with milder forms of the condition may benefit from topical treatment.
Because alopecia areata doesn’t cause any actual or permanent damage to the hair follicle, many people with alopecia areata who only have a few patches of hair loss experience a full recovery without the need for any treatment.
Corticosteroids, which are synthetic steroid hormones that suppress the immune system, are one of the most common alopecia areata treatments. A doctor will either prescribe a topical cream, lotion, or ointment that’s applied to the areas of hair loss or inject the medication directly into the bald spots to help stimulate the hair growth process. In some cases, patients take corticosteroid pills, but that’s not as common because oral corticosteroids present the biggest risk for side effects.
Minoxidil is another line of defense against hair loss that’s most often used in conjunction with another treatment method, such as corticosteroids. Patients with alopecia areata apply minoxidil, which triggers hair regrowth, to areas of hair loss twice a day. Usually, hair regrowth becomes apparent in about three months.
Diphencyprone is a unique class of medication that works in the treatment of alopecia areata by provoking an allergic skin reaction. Patients apply diphencyprone directly to bald areas, which causes redness, itching, and inflammation. This allergic immune reaction forces white blood cells to rush to the bald areas in the scalp, which stimulates hair follicles and battles the inflammation caused by the autoimmunity. As with minoxidil, hair regrowth typically takes approximately three months.
Dermatologists classify medical treatment using anthralin as short-contact therapy. Anthralin is a thick, tar-like substance that’s applied directly to the bald areas of skin and left on for 20 minutes to an hour. The medication disrupts the immune function of the skin and slows down the growth of skin cells, interrupting the pattern of autoimmunity. Anthralin should only be used on the scalp, not the face.
In some cases, alternative treatments such as acupuncture, herbal supplements, and nutritional therapy, are used in patients with alopecia areata. Rather than directly targeting the hair loss like topical medication, these therapies are aimed at correcting the underlying cause of the alopecia areata—autoimmune disease.
In most cases, health care professionals take a multifaceted approach to treatment and use a combination of therapies and medical interventions. Most patients with alopecia areata eventually experience a complete regrowth of hair, although many people lose their hair more than once before the condition gets completely corrected. At first, new hair may be white and finer than existing hair, but normal color and texture typically return within a few months of hair regrowth.
Alopecia areata affects one's self esteem when there is not an outlet of support. The National Alopecia Areata Foundation is a wonderful resource that offers support groups, mentor programs, and even new treatment options if you or a loved one is in need of further alopecia areata guidance.