Treating alopecia areata (autoimmune hair loss)

Alopecia areata simply means ‘hair loss’, and is a condition whereby hair is lost from any area on the body, typically in bald patches.

This condition might also be called autoimmune alopecia, since it is believed to be an autoimmune condition. Alopecia areata can affect hair anywhere on the body, including the scalp, eyebrows, eyelashes and facial hair.

Most people have no other symptoms, but start to notice a bald patch appearing somewhere, perhaps at the hairdresser. There may be a sensation of prickling or discomfort in the affected area, known as trichodynia. Alopecia areata may appear with nail symptoms, known as trachyonychia.

What we know about alopecia areata: 

• Anyone of any age from any country can develop alopecia areata, with about half of all cases starting in childhood, and about 80 per cent starting prior to age 40.
• A family history of alopecia areata or another autoimmune condition exists in up to 25 per cent of those with alopecia areata.
• Up to eight susceptibility genes have been found.
• Those with alopecia areata have higher than average rates of vitiligo, eczema and thyroid conditions.
• People with Down’s syndrome have alopecia areata more often.
• Some medication can trigger alopecia areata.
• A virus, trauma, hormonal change or emotional or physical stress may trigger onset or recurrence of alopecia areata.
• This is what can cause ‘going white overnight’ due to shock or trauma (see more about going grey here).

Why does the hair fall out and stop growing?

The T cells in the hair follicles release inflammatory molecules that reject the hair in the follicle, but we’re not sure why.

Hair-loss treatments for alopecia areata

Hair-loss treatments are evolving, with a new treatment looking very promising. Traditional treatments include:

• Topical treatments that can improve hair growth in some people, but hair falls out when treatment ends (topical steroids and prescription ointments)
• Corticosteroid injections into the bald areas, which helps speed up hair growth, but is temporary
• Systemic corticosteroids via intravenous injection can temporarily regrow hair, however this treatment cannot be justified long term due to adverse effects
• Immunotherapy, such as causing contact allergic dermatitis in affected areas to deliberately irritate the skin to stimulate the hair follicle
• Lipid-lowering treatments that may have immune effects
• JAK inhibitors – latest new treatments that look promising

Counselling is recommended, since losing one’s hair in patches without a cure in sight can be quite terrifying. Camouflage is therefore a suitable goal, and can be achieved via various mechanisms. Typically the eyebrows, eyelashes and head hair are the most missed areas of hair, which can be replaced with a wig or hairpiece, false eyelashes (including for men), and eyebrows drawn on or even tattooed on. Each of these solutions comes with its own issues, so speak to your cosmetic dermatologist for more solutions.

In 80 per cent of people with a single bald patch, the hair grows back spontaneously within a year. Most people, even with severe alopecia areata, see either a full or partial recovery.

Let us delve into your alopecia areata. 
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