Is Most Likely To Get It?
areata affects an estimated four million Americans of both
sexes and of all ages and ethnic backgrounds. It often
begins in childhood, but as many autoimmune disease change
the cycle of cell replication, it is possible to occur at
If you have a
close family member with the disease, your risk of
developing it is slightly increased. If your family member
lost his or her first patch of hair before age 30, the risk
to other family members is greater. Overall, one in five
people with the disease have a family member who has it as
Hair Loss a Symptom of a Serious Disease?
areata is not a life-threatening disease. It does not cause
any physical pain, and people with the condition are
generally healthy otherwise. But for most people, a disease
that unpredictably affects their appearance the way alopecia
areata does is a serious matter.
The effects of
alopecia areata are primarily socially and emotionally
disturbing. In alopecia universalis, however, loss of
eyelashes and eyebrows and hair in the nose and ears can
make the person more vulnerable to dust, germs, and foreign
particles entering the eyes, nose, and ears.
areata often occurs in people whose family members have
other autoimmune diseases, such as diabetes, rheumatoid
arthritis, thyroid disease, systemic lupus erythematosus,
pernicious anemia, or Addison's disease. People who have
alopecia areata do not usually have other autoimmune
diseases, but they do have a higher occurrence of thyroid
disease, atopic eczema, nasal allergies, and asthma.
Pass It on to My Children?
possible, but not likely, for alopecia areata to be
inherited. Most children with alopecia areata do not have a
parent with the disease, and the vast majority of parents
with alopecia areata do not pass it along to their children.
areata is not like some genetic diseases in which a child
has a 50-50 chance of developing the disease if one parent
has it. Scientists believe that there may be a number of
genes that predispose certain people to the disease. It is
highly unlikely that a child would inherit all of the genes
needed to predispose him or her to the disease.
Even with the
right (or wrong) combination of genes, alopecia areata is
not a certainty. In identical twins, who share all of the
same genes, the concordance rate is only 55 percent. In
other words, if one twin has the disease, there is only a 55
percent chance that the other twin will have it as well.
This shows that other factors besides genetics are required
to trigger the disease.
To learn more
about the genes and other factors involved in alopecia
areata risk, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is funding an
alopecia areata registry. The registry is an organized
network of five centers throughout the United States that
will identify and register patients with the disease and
collect data and blood samples (which contain genes). Data,
including genetic information, will be made available to
researchers studying the genetic basis and other aspects of
disease and disease risk. (For more information about the
Hair Ever Grow Back?
There is every
chance that your hair will regrow, but it may also fall out
again. No one can predict when it might regrow or fall out.
The course of the disease varies from person to person. Some
people lose just a few patches of hair, then the hair
regrows, and the condition never recurs. Other people
continue to lose and regrow hair for many years. A few lose
all the hair on their head; some lose all the hair on their
head, face, and body. Even in those who lose all their hair,
the possibility for full regrowth remains.
In some, the
initial hair regrowth is white, with a gradual return of the
original hair color. In most, the regrown hair is ultimately
the same color and texture as the original hair.
Can I Expect Next?
The course of
alopecia areata is highly unpredictable, and the uncertainty
of what will happen next is probably the most difficult and
frustrating aspect of the disease. You may continue to lose
hair, or your hair loss may stop. The hair you have lost may
or may not grow back, and you may or may not continue to
develop new bare patches.
Is It Treated?
While there is
neither a cure for alopecia areata nor drugs approved for
its treatment, some people find that medications approved
for other purposes can help hair grow back, at least
temporarily. The following are some treatments for alopecia
areata. Keep in mind that while these treatments may promote
hair growth, none of them prevent new patches or actually
cure the underlying disease. Consult your health care
professional about the best option for you.
Corticosteroids--Corticosteroids are powerful
anti-inflammatory drugs similar to a hormone called
cortisol produced in the body. Because these drugs
suppress the immune system if given orally, they are
often used in the treatment of various autoimmune
diseases, including alopecia areata. However, due to the
implications of fungal exposure, it is not always wise
to consider this as a frequent option.
Corticosteroids may be administered in three ways for
injections--Injections of steroids directly
into hairless patches on the scalp and sometimes the
brow and beard areas are effective in increasing
hair growth in most people. It usually takes about 4
weeks for new hair growth to become visible.
Injections deliver small amounts of cortisone to
affected areas, avoiding the more serious side
effects encountered with long-term oral use. The
main side effects of injections are transient pain,
mild swelling, and sometimes changes in
pigmentation, as well as small indentations in the
skin that go away when injections are stopped.
Because injections can be painful, they may not be
the preferred treatment for children. After 1 or 2
months, new hair growth usually becomes visible, and
the injections usually have to be repeated monthly.
The cortisone removes the confused immune cells and
allows the hair to grow. Large areas cannot be
treated, however, because the discomfort and the
amount of medicine become too great and can result
in side effects similar to those of the oral
corticosteroids--Corticosteroids taken by
mouth are a mainstay of treatment for many
autoimmune diseases and may be used in more
extensive alopecia areata. But because of the risk
of side effects of oral corticosteroids, such as
hypertension and cataracts, they are used only
occasionally for alopecia areata and for shorter
periods of time.
ointments--Ointments or creams containing
steroids rubbed directly onto the affected area are
less traumatic than injections and, therefore, are
sometimes preferred for children. However,
corticosteroid ointments and creams alone are less
effective than injections; they work best when
combined with other topical treatments, such as
minoxidil or anthralin.
- Minoxidil (5%)
(Rogaine*)--Topical minoxidil solution promotes hair
growth in several conditions in which the hair follicle
is small and not growing to its full potential.
Minoxidil is FDA-approved for treating male and female
pattern hair loss. It may also be useful in promoting
hair growth in alopecia areata. The solution, applied
twice daily, has been shown to promote hair growth in
both adults and children, and may be used on the scalp,
brow, and beard areas. With regular and proper use of
the solution, new hair growth appears in about 12 weeks.
Anthralin (Psoriatec)--Anthralin, a
synthetic tar-like substance that alters immune function
in the affected skin, is an approved treatment for
psoriasis. Anthralin is also commonly used to treat
alopecia areata. Anthralin is applied for 20 to 60
minutes ("short contact therapy") to avoid skin
irritation, which is not needed for the drug to work.
When it works, new hair growth is usually evident in 8
to 12 weeks. Anthralin is often used in combination with
other treatments, such as corticosteroid injections or
minoxidil, for improved results.
sulfa drug, sulfasalazine has been used as a treatment
for different autoimmune disorders, including psoriasis.
It acts on the immune system and has been used to some
effect in patients with severe alopecia areata.
sensitizers--Topical sensitizers are
medications that, when applied to the scalp, provoke an
allergic reaction that leads to itching, scaling, and
eventually hair growth. If the medication works, new
hair growth is usually established in 3 to 12 months.
Two topical sensitizers are used in alopecia areata:
squaric acid dibutyl ester (SADBE) and
diphenylcyclopropenone (DPCP). Their safety and
consistency of formula are currently under review.
cyclosporine--Originally developed to keep
people's immune systems from rejecting transplanted
organs, oral cyclosporine is sometimes used to suppress
the immune system response in psoriasis and other
immune-mediated skin conditions. But suppressing the
immune system can also cause problems, including an
increased risk of serious infection and possibly skin
cancer. Although oral cyclosporine may regrow hair in
alopecia areata, it does not turn the disease off. Most
doctors feel the dangers of the drug outweigh its
benefits for alopecia areata.
Photochemotherapy--In photochemotherapy, a
treatment used most commonly for psoriasis, a person is
given a light-sensitive drug called a psoralen either
orally or topically and then exposed to an ultraviolet
light source. This combined treatment is called PUVA. In
clinical trials, approximately 55 percent of people
achieve cosmetically acceptable hair growth using
photochemotherapy. However, the relapse rate is high,
and patients must go to a treatment center where the
equipment is available at least two to three times per
week. Furthermore, the treatment carries the risk of
developing skin cancer.
therapies--When drug treatments fail to bring
sufficient hair regrowth, some people turn to
alternative therapies. Alternatives purported to help
alopecia areata include acupuncture, aroma therapy,
evening primrose oil, zinc and vitamin supplements, and
Chinese herbs. Because many alternative therapies are
not backed by clinical trials, they may or may not be
effective for regrowing hair. In fact, some may actually
make hair loss worse. Furthermore, just because these
therapies are natural does not mean that they are safe.
As with any therapy, it is best to discuss these
treatments with your doctor before you try them.
In addition to
treatments to help hair grow, there are measures that can be
taken to minimize the physical dangers or discomforts of
- Sunscreens are
important for the scalp, face, and all exposed areas.
- Eyeglasses (or
sunglasses) protect the eyes from excessive sun, and
from dust and debris, when eyebrows or eyelashes are
- Wigs, caps, or scarves
protect the scalp from the sun and keep the head warm.
- Antibiotic ointment
applied inside the nostrils helps to protect against
organisms invading the nose when nostril hair is
Will Alopecia Areata Affect My Life?
This is a
common question, particularly for children, teens, and young
adults who are beginning to form lifelong goals and who may
live with the effects of alopecia areata for many years. The
comforting news is that alopecia areata is not a painful
disease and does not make people feel sick physically. It is
not contagious, and people who have the disease are
generally healthy otherwise. It does not reduce life
expectancy and it should not interfere with the ability to
achieve such life goals as going to school, working,
marrying, raising a family, playing sports, and exercising.
aspects of living with hair loss, however, can be
challenging. Many people cope by learning as much as they
can about the disease; speaking with others who are facing
the same problem; and, if necessary, seeking counseling to
help build a positive self-image. To address quality-of-life
issues for alopecia areata and all other skin diseases, the
NIAMS sponsored a scientific meeting in September 2002 on
the burden of skin diseases.
Can I Cope With the Effects of This Disease?
hair loss can be hard, especially in a culture that views
hair as a sign of youth and good health. Even so, most
people with alopecia areata are well-adjusted, contented
people living full lives.
A possible way
to cope with the disease is to minimize its effects on your
appearance. If you have total hair loss, a wig or hairpiece
can look natural and stylish. For small patches of hair
loss, a hair-colored powder, cream, or crayon applied to the
scalp can make hair loss less obvious by eliminating the
contrast between the hair and the scalp. Skillfully applied
eyebrow pencil can mask missing eyebrows.
alopecia areata may prefer to wear bandanas or caps. There
are many styles available to suit a child's interest and
mood-some even have ponytails attached.
attractive scarves can hide patchy hair loss; jewelry and
clothing can distract attention from patchy hair; and proper
makeup can camouflage the effects of lost facial hair. If
you would like to learn more about camouflaging the cosmetic
aspects of alopecia areata, ask your doctor or members of
your local support group to recommend a cosmetologist who
specializes in working with people whose appearance is
affected by medical conditions.
This site is not intended to give medical advice.
Seek the advice of a professional for diagnosis, medication, treatment
options, and complete knowledge of any illness. The opinions expressed
here are exclusively my personal opinions do not necessarily reflect my
peers or professional affiliates. The information here does not reflect
professional advice and is not intended to supersede the professional advice