Alopecia Areata

Alopecia areata is a well-known autoimmune disease that attacks the hair follicles, leading to patchy hair loss.

It is very common in men's beards where small bald patches appear and then self-resolve. Often these events go undetected and/or not formally diagnosed. In many cases, the new hair grows back white without any pigmentation.

In most cases, alopecia areata begins on the scalp. The location is random and can happen sporadically on any healthy individual. The initial patch usually measures between 0.5 cm and 2 cm. If left untreated, the alopecia areata bald patch tends to either:

1) grow wider – often over the next 2–6 months or
2) stabilise and either remain bald or grow back similar or thinner hair, often white without pigmentation.

Treatment for Alopecia Areata

Steroids are the most effective and common strategy of treatment. The success rate is higher when treatment is started early after a new bald patch is found. The odds of “complete resolution” are lower if the patch has been left untreated for longer than 6 months.

Steroids can be used in different forms:

Injection
Intradermal injection of steroids is the most successful treatment strategy with the highest “restitution” of normal hair growth. If treatment is started quickly, typically only 2–5 sessions are required, with a gap of 4–6 weeks between them. A session lasts 5–15 minutes, depending on the size.
Oral
The "mini-pulse" is a new treatment that often helps control progressive disease. It can reduce the formation of new patches and has a lower chance of side effects than topical or oral/systemic steroids.
Topical/cream
While many steroid creams and lotions are available, the success rate is much lower than using any other form of steroid.

Causes

The causes of alopecia areata are not clear. In fact, most affected individuals present with no symptoms or health problems at all. Associated diseases include type 1 diabetes, rheumatoid arthritis and coeliac disease. There is also an association with a disrupted metabolism of retinoids, but there is no clear understanding of how this affects the development of hair loss in the specific “patchy shape”, typical of alopecia areata.

Presentation

Alopecia areata often presents as one round or oval patch on the scalp or beard, with sizes ranging from 0.3 cm to 3 cm. The shape may seem irregular as a result of two or more bald patches overlapping each other.

Progression

The progression of the disease is unpredictable. Without treatment, patients may experience an enlargement of the primary patch or the emergence of new patches in other areas such as the scalp, eyebrows, beard or other parts of their body.

In many cases, particularly when young, the initial body response is effective, with new hair growing within 6 months.

Prognosis

Patients having an initial patch are more likely than the general population to develop a new one in the future.

Those with a family history of alopecia areata type hair loss are more likely to develop a similar type of “patchy” hair loss.

The progression of the disease is completely unpredictable if left alone without treatment. However, steroid treatment is the most successful at both restoring hair growth and preventing new hair loss.

Rapidly Progressing Alopecia

We Can Help

Each case of hair loss is unique and we understand your goals are personal to you. We can help you understand your individual case of hair loss and walk you through your options. Please call the London Hair Loss Clinic today on 020 7666 3147.

LONDON HAIR LOSS CLINIC