Etiology and Clinical Presentation:
Alopecia areata is an immune-mediated inflammatory disorder characterized by hair loss, which can occur in small patches or over large areas of the scalp, body hair, eyelashes, and/or eyebrows. Most patients who develop alopecia areata are under the age of 30, but it can begin at any age. Alopecia areata can be self-limiting - 50% of patients will see complete hair regrowth within 1 year without treatment, but most will relapse months or years after remission. The exact mechanism of alopecia areata is unknown, but we do understand that there is an inflammatory immune response around the hair follicle, which leads to damage and eventually hair loss. There are no biological markers to detect alopecia areata, but there are known risk factors, including: family history of alopecia areata, comorbid asthma, hay fever, atopic dermatitis, thyroid disease, vitiligo, or downs syndrome. Alopecia areata can also be drug-induced - this is commonly seen with chemotherapeutic agents such as nivolumab (nivolumab-induced alopecia areata). Your race may also affect your risk of getting alopecia areata. In a large study, researchers found that black and Hispanic nurses were more likely than non-Hispanic white nurses to develop this disease. The decision to treat alopecia areata should be done based on severity of the disease and psychosocial implications of hair loss in young adults. For example, an older male adult may not request treatment, but a 20-year old patient may become extremely distressed by repetitive loss of hair. Below is a summary of treatment strategies currently recommended for alopecia areata:
Investigational and Approved Treatment Options for Alopecia Areata (2021)
Resources:
Messenger A. Alopecia areata: Management. UpToDate. https://www-uptodate-com.jerome.stjohns.edu/contents/alopecia-areata-management?search=alopecia%20areata&source=search_result&selectedTitle=1~60&usage_type=default&display_rank=1. Last Updated 03/03/2021.
Alopecia is a medical condition involving the loss of hair on varying parts of the body including eyebrows, eyelashes, and primarily the scalp. This can be the result of aging, hormones, stress, medical conditions, medications, anemia, infections, and various other conditions. It can affect any gender temporarily or permanently, reducing the individual’s quality of life. It is important to assess for any risk factors or lifestyle behaviors that may induce alopecia. Recognizing the cause allows us to directly treat it, otherwise, patients are left with an array of treatment options.
In alopecia, the hair follicles may be preserved, allowing for regrowth and reversal of the loss. There are many types of alopecia such as alopecia areata, androgenetic alopecia, chemotherapy-induced alopecia, frontal fibrosing alopecia, trichotillomania alopecia, etc. Androgenetic alopecia is hereditary alopecia in which we can see male-pattern baldness or female-pattern baldness. This is the most common type of alopecia, with a 2019 multicenter retrospective study reporting a frequency of 37.7% of androgenetic alopecia. Alopecia areata is a chronic immune-mediated disease resulting in patchy hair loss on the scalp, affecting children and adults of all ages. That same study respectively reported an 18.2% frequency.
The Severity of Alopecia Tool (SALT) score guides providers in therapeutic decision-making in alopecia areata patients. After dividing the scalp into four quadrants, the percentage of hair loss is estimated, allowing provides to monitor therapeutic response. Laboratory testing should be performed to find underlying causes or comorbidities. Tests may include a CBC, CMP, iron panel, and TSH levels. Many patients are referred to specialists such as dermatologists to further inquire into the cause of the hair loss.
In the case of androgenetic alopecia, treatments target hair loss prevention as opposed to regrowth. First-line treatments include oral finasteride and/or topical minoxidil. Minoxidil is available over the counter as a generic product or popular topical Rogaine in drugstores. it is important to note that results are not seen immediately and may take 2-3 months to be seen. Patients can opt for other treatments offered in dermatology clinics that are not covered by insurance. Laser therapy, micro-needling, and platelet-rich plasma injections have shown efficient results. A popular cosmetic trend on the rise at the moment is hair transplants. Many countries offer affordable prices and are both reputable and successful, showing promising results. An overlooked treatment option is ensuring patients are receiving nutritious diets. Nutritional deficiencies are a common cause of hair loss.
Alopecia has no negative harm to the body physically, however, the emotional and psychological effects make all parties vulnerable to society’s eyes. People become more self-conscious and anxious, lowering their self-esteem. For patients unable to afford the stated treatment methods, an Ayurvedic approach may be more feasible. With the rising trends seen online and passed down generations, rosemary oil, and castor oil have been sold religiously on various sites and shops. Beauty and Ayurvedic companies have released serums and supplements that encourage hair regrowth. It is both the provider's and the patient’s responsibility to see what treatment options best work for the patient.
References
https://www.ncbi.nlm.nih.gov/books/NBK538178/
https://my.clevelandclinic.org/health/diseases/12423-alopecia-areata
https://www.niams.nih.gov/health-topics/alopecia-areata
https://www.aad.org/public/diseases/hair-loss/types/alopecia