Alopecia

Alopecia

Alopecia is a condition that causes hair loss. It can affect any part of the body, but most commonly affects the scalp. There are different types of alopecia, each with its own specific pathophysiology, signs, symptoms, investigations, and treatment options.

Case:
A 35-year-old woman presents with sudden hair loss on the scalp. She reports no history of medical illness, and there is no family history of alopecia. On examination, there are round patches of hair loss on the scalp. There is no scaling or inflammation. The remaining hair is easily plucked, confirming the diagnosis of alopecia areata.

Pathophysiology

Alopecia areata is an autoimmune condition where the body’s immune system attacks hair follicles, leading to hair loss. The exact cause of this autoimmune reaction is not known, but it is believed to be triggered by a combination of genetic, environmental, and immune factors. In some cases, the condition can progress to alopecia totalis or alopecia universalis, where there is total hair loss on the scalp or the entire body, respectively.

Signs and Symptoms

The main symptom of alopecia is hair loss, which can occur suddenly or gradually. In alopecia areata, hair loss typically occurs in round patches on the scalp, but it can also affect other parts of the body. The skin in the affected areas is usually smooth and unscarred, with no signs of inflammation or scaling. In more severe cases of alopecia totalis or universalis, there is total hair loss on the scalp or the entire body.

Investigations

Diagnosis of alopecia is usually based on a clinical examination and medical history. In some cases, a scalp biopsy may be performed to confirm the diagnosis and rule out other causes of hair loss. Blood tests may also be done to check for underlying medical conditions that may be contributing to hair loss, such as thyroid disorders or anemia.

Treatment

There is no cure for alopecia, but there are various treatment options that can help manage the condition. In mild cases of alopecia areata, hair may regrow on its own without treatment. However, if the condition is more severe, treatment options may include:

  • Corticosteroid injections or creams to suppress the immune system and reduce inflammation
  • Topical minoxidil to stimulate hair growth
  • Immunomodulators such as JAK inhibitors to regulate the immune response
  • Hair transplant surgery or scalp micropigmentation to create the appearance of hair

Dos and Don’ts

If you have been diagnosed with alopecia, here are some dos and don’ts to keep in mind:

Dos:

  • Consult a dermatologist who specializes in hair loss
  • Consider using a wig, scarf, or hat to cover areas of hair loss
  • Take steps to reduce stress, as stress can exacerbate alopecia symptoms
  • Eat a healthy and balanced diet to promote hair growth
  • Be patient and give treatments time to work

Don’ts:

  • Avoid harsh hair treatments such as perms, dyes, and chemical straightening
  • Do not overstyle your hair, as this can put additional stress on hair follicles
  • Do not use tight hairstyles such as braids, ponytails, or extensions, which can cause traction alopecia and worsen hair loss
  • Do not use unproven remedies or supplements without consulting a healthcare professional

References

  • Khatu SS, More YE, Gokhale NR, et al. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014;7(2):107-110. doi:10.4103/0974-2077.138352
  • Tosti A, Piraccini BM, Saceda-Corralo D, et al. Alopecia areata: A long term follow-up study of 191 patients. J Am Acad Dermatol. 2016;75(4): 723-728. doi: 10.1016/j.jaad.2016.05.045
  • Gilhar A, Etzioni A, Paus R. Alopecia areata. N Engl J Med. 2012;366(16):1515-1525. doi: 10.1056/NEJMra1103442
    Messenger AG, McKillop J, Farrant P, et al. British Association of Dermatologists‘ guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166(5):916-926. doi: 10.1111/j.1365-2133.2012.10897.x
  • Kanti V, Messenger AG, Dobos G, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2018;16(5): 580-596. doi: 10.1111/ddg.13503
  • Price VH. Androgenetic alopecia in women. J Investig Dermatol Symp Proc. 2003;8(1):24-27. doi: 10.1046/j.1523-1747.2003.12177.x

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