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Alopecia Areata

Alopecia areata also referred to as AA causes the loss of hair in small patches.  In some cases this condition may resolve without treatment, other times it can last for several years.  Approximately 2% of North Americans may develop AA during their lifetime.  About 5% of patients with AA will lose all of their scalp hair, a condition known as alopecia totalis, when patients lose all of their body hair the condition is called alopecia universalis.  Doctors do not know why a patient’s immune system attacks his or her hair roots, resulting in hair loss.

This condition affects both men and women worldwide; it is also found in all ethnic groups.  Although people of all ages may develop AA; it most frequently impacts young adults and children.  Genetics may play a role; nearly 20% of people with AA have at least one member of their family who has the condition.

The Symptoms & Signs Of AA
One of the first warning signs is one or more bare patches that are small about the size of a coin, and round.  It normally affects the scalp, although it can impact any area were hair grows such as the eyelashes, eyebrows, or beards.  The hair can fall out then later regrow fully or partially.  Typically there are no symptoms associated with AA, although some patients experience itching or discomfort prior to the development of new patches.  Patients may notice small pinpoint dents in their nails.

The Causes of AA
One of the first things you should know about AA is that it is not contagious.  It is the results of an autoimmune condition where the immune system attacks the body.  For patients with AA the immune system attacks the hair follicles.  Doctors do not know what causes this condition.  AA is triggered by a person's genetic makeup in combination with other factors.

How Is AA Diagnosed?
Your dermatologist will often know by conducting a visual examination of your scalp, occasionally, a biopsy of the scalp is used when confirming the doctor’s diagnosis of AA.

Can AA Be A Sign Of A Health Threat Or Disease?
Most patients who suffer from AA are healthy individuals, it is not indicative of something more serious.  People who have AA may be at an elevated risk of developing other autoimmune conditions such as vitiligo and thyroid disease (such as Hashimoto's thyroiditis).  Some other conditions that are common among patients with AA are asthma, nasal allergies, and atopic eczema.  In addition, patients suffering from AA are likely to have family members with have asthma, atopic eczema, nasal allergies, or other autoimmune diseases (e.g. Rheumatoid arthritis, Insulin-dependent diabetes, systemic lupus erythematosus, or thyroid disease).

Hair Regrowth
While it is very likely the hair will regrow there is a strong possibility that the patient will lose it again.  The disease differs from patient to patient, and it is impossible to tell when the hair will regrow or if they will experience hair loss again.  This condition can be very frustrating for patients because of its unpredictability.  Some patients lose just a few patches of their hair, and then it later regrows, in some cases the condition never returns, other patients’ experience a cycle of hair loss and regrowth that lasts many years.  It is possible for patients to fully regrow their hair, even in cases were the patient has lost all the hair on his or her scalp and body (alopecia totalis/universalis).  When the hair regrows it can be white or have a fine texture, later the original color and texture may return.

How AA Is Treated
Unfortunately AA is not curable.  Some treatments can promote the grown of hair, although new patches of AA may continue appearing.  The treatments for AA are not a cure, only the body can eventually stop the cycle of hair loss and regrowth.
  • Topical minoxidil 5% can promote hair growth in patients with AA.  When Minoxidil 5% solution is applied twice daily to the beard areas, brow, and scalp it can promote hair growth in both children and adults with AA.  New hair growth may appear in about 12 weeks.
  • DPCP (Diphenylcyclopropenone)/SADBE (Squaric Acid Dibutyl Ester) are topical immunotherapies that are sometimes effective in extensive alopecia areata (AA).  Though the treatment may have some side effects, in most cases they are tolerable.
  • Corticosteroids, these are anti-inflammatory drugs that work to suppress the immune system.  They can be injected into the areas where hair loss is occurring, rubbed into affected areas, or taken as pills.  Steroid injections are given every 4-6 weeks and are injected directly into scalp, eyebrow, or beard areas where the hair is missing.  Hair growth normally begins 4 weeks after the injection.  Steroids that are applied directly to the affected areas are generally slower and less effective than the injections.  Corticosteroids taken orally have potential side effects.  For this reason oral steroids are not used routinely, although they may be used under certain circumstances.  New non-steroid anti-inflammatory creams are occasionally used such as Tacrolimus (especially on the face).

Other Alternatives
Hats, wigs, caps, and scarves can conceal AA without interfering with hair regrowth.  This could be a good option for people suffering from extensive scalp hair loss.

How AA Can Affect Daily Life
For some patients the emotional side of dealing with hair loss is a challenge.  It is reassuring that AA does not impact patients’ general health, and should not restrict their ability to achieve all of their life goals such as sports, school, career, and raising a family.

Learn more:       

We put academic qualifications, many years of combined experience, and training in a variety of special interest areas to work for your healthy, radiant skin. Our providers – Drs. Schachter, Hanna, Curtis, Abdulla, Pollack, and Taradash – welcome new patients for treatment at the Dermatology on Bloor practice on Park Road in Toronto. Our team is here to serve your needs
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