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What is alopecia areata and how is it managed?

What is alopecia areata and how is it managed?

Alopecia has recently made headlines. But what exactly does alopecia imply? Alopecia is a catch-all term for all types of hair loss. Hair loss is a common problem for many men and women, and the majority of people will experience some form of hair loss during their lives.

Alopecia areata (AA) is a condition in which the body's immune system attacks hair follicles, causing hair loss. AA can affect the scalp, brows, eyelashes, and any other area of the body where hair grows.


What exactly causes alopecia areata?

The immune system defends the body from foreign invaders such as bacteria and allergens. When the immune system is not functioning properly, it can attack hair follicle cells, causing them to enter their "resting" phase (called telogen) prematurely, halting hair growth.

Although the exact cause of this immune response is unknown, environmental factors, genetics, and stress may all play a role.

Patients of all ethnicities and genders are affected by AA. It is one of the most common types of hair loss. The majority of people who develop AA are under the age of 30, but it can occur at any age.

What is the appearance of alopecia areata?
AA typically begins with the appearance of small, round patches of hair loss with no redness or scarring. This can rarely progress to a complete lack of body and scalp hair, including brows and eyelashes.

A doctor's examination (usually by a dermatologist) is often used to make the diagnosis, which may include the use of a dermoscope (skin surface microscope). If it is unclear whether AA is the cause of hair loss, the doctor may perform a scalp biopsy (the removal of a small amount of skin) to help make a more accurate diagnosis.

Nail changes occur in approximately 10% to 20% of patients and may be more common in children or those with severe cases.

Because AA is an autoimmune disorder, it's not surprising that it's linked to other immune-related conditions like vitiligo, autoimmune hemolytic anaemia, celiac disease, lupus, allergic rhinitis, asthma, atopic dermatitis, and thyroid disease. Thyroid blood tests are frequently performed to rule out thyroid conditions that cause hair loss.

AA frequently causes psychological and emotional distress, as well as a decrease in self-esteem. Anxiety, depression, and obsessive-compulsive disorder are all more common in AA users.

What is the outlook for people suffering from alopecia areata?
Although the natural course of AA is unpredictable, most people with the condition achieve hair regrowth within a few years. Patients with milder hair loss are more likely to experience regrowth. The AA subtype also influences the prognosis: the risk of progression from limited alopecia areata to complete scalp hair loss (alopecia totalis) or whole-body hair loss (alopecia universalis) is about 5% to 10%.

The extent of hair loss and the age at which AA begins are the most important prognostic indicators. People who develop AA at a younger age tend to fare the worst. Certain subtypes of AA may also be less amenable to treatment.


What are the available treatments for alopecia areata?
Before beginning treatment, it is critical to have realistic expectations and understand that there is currently no cure for AA and that the goals of treatment are to suppress hair loss and promote regrowth. Recurrence is possible due to the unpredictable nature of AA, with only 30% of patients experiencing long-term remissions.

Because of the minimal side effects, ease of application, and excellent response in most low-severity cases, topical steroids (applied at home by the patient) or locally injected steroids (applied by the doctor) are the first treatment options for patients with limited, patchy AA. Specific topical irritating medications are occasionally applied to the scalp in an attempt to reset the autoimmune process and regrow hair. Some of these prescriptions include squaric acid or anthralin (which may have other brand names), and they are also administered during doctor's appointments.

Systemic steroids or other immunosuppressants can be used to treat rapidly progressing or widespread alopecia. JAK inhibitors, a newer class of medications, have recently shown promise in improving even advanced AA, but there is a high relapse rate if treatment is stopped. Nonetheless, many clinical trials for new AA treatments are being conducted.

Family and patient education, as well as psychological support, are critical components of AA management. In more severe or nonresponsive cases, prosthetic and cosmetic options, such as wigs, are also available. The National Alopecia Areata Foundation website lists support groups.


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