Blog

ALOPECIA AREATA

This describes the sudden appearance of a circumscribed totally bald patch, or patches. The diagnosis of this kind of hair loss is characteristic of the following signs.The follicles within the patch are visible. The skin in (Caucasians) is white. It appears very suddenly, sometimes preceded by itching. Around the periphery of the patch there are very short stumps of hair, these are called exclamation hairs and under the microscope show where the shaft of the hair has been weakened by Auto- immune dysfunction. These hairs also show the patch is extending. Regrowth  is  marked by vellus unpigmented hair usually growing from the centre. Areas on the scalp usually involved are: Occipital, ( nape of neck), Auricular (above the ears). Ophiasic (around the margins, recovery in this area is usually slower than auricular and occipital). Its course is extremely unpredictable, and intermittent relapses are common. Regrowth can occur within weeks or sometimes up to a year or so. Associated signs include sudden loss of pigment in a patch on the skin, this can happen anywhere on the body. Nail pitting is a common sign and the Atopic State -(Asthma, Hayfever, and Eczema). Is a common co factor.

Do you have Hair Loss Problems, read our Hair Loss Help

More treatment options for alopecia areata

BEFORE AND AFTER TREATMENT AT THE HAIR CENTRE 

These results were achieved with a combination of treatment therapy.

Topical immunotherapy

It is thought that topical immunotherapy is the most effective option for people with extensive alopecia areata. However, this treatment is only done by some skin specialist and so you will need to be referred to one of these specialists for it.

How topical immunotherapy works is not clear. A substance is put on affected skin to to make the skin react like an allergy. The most commonly used substance is DPCP (diphencyprone). Increasing strengths of this substance are placed on the affected skin once a week over several weeks until the skin looks like it has mild dermatitis (eczema). The skin reaction seems to affect the process involved in causing alopecia areata in some way to allow hair to re-grow. Side-effects from topical immunotherapy can be troublesome. For example, some people develop severe skin reactions. Treating children with topical immunotherapy is controversial.

In a large study of people with extensive alopecia areata, topical immunotherapy caused good hair re-growth in 3 in 10 cases after six months which increased to nearly 8 in 10 cases after 32 months of treatment. (It worked less well in people with alopecia totalis or alopecia universalis.) In those where it works, initial re-growth does not occur for 12-24 weeks. Once re-growth occurs, treatment can be stopped but in many cases the hair loss then recurs. Therefore, in many cases, regular maintenance treatment is needed to keep the hair loss from returning.
 

Dithranol

Dithranol is thought to be less effective than topical immunotherapy, but works in some cases. It is applied each day to the whole scalp if there is extensive hair loss and left for 20-60 minutes before washing it off. One study showed that it helps hair re-growth in about 1 in 4 cases, but takes many weeks of treatment. Side-effects such as itchiness, redness, and scaling are common with dithranol. Dithranol is not widely used for alopecia areata because it is messy to use.

Do you have Hair Loss Problems, read our Hair Loss Help

More treatment options for alopecia areata

Topical (‘rub-on’) steroid

Steroid cream, gel, etc, may help hair re-growth, but does not work as well as steroid injections. It may be worth a try if you have bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist to have steroid injections. If re-growth occurs it takes 3-6 months. There is no point continuing with this treatment if no re-growth occurs after six months.

Minoxidil solution

This is rubbed into the bald patches and has been shown to promote hair re-growth in some cases. This is the same treatment that is used for the common ‘male pattern’ baldness. It is not known how it works. The success rate is not high but may be worth a try. In particular, if you have more extensive bald patches that are not suitable for steroid injections, or if you are waiting to see a specialist for steroid injections.

Minoxidil is not available on the NHS. You need a private prescription and have to pay the full cost of the product, which makes it expensive. If it works, it usually takes 2-3 months of treatment for an initial response, and one year for a maximum response. There is no point continuing with this treatment if there is no improvement after one year.

Some people feel that combining a topical steroid with minoxidil gives a higher chance of hair re-growth than either treatment alone. However, there is little research evidence to prove this.

Do you have Hair Loss Problems, read our Hair Loss Help

What are the treatment options for alopecia areata?

Not treating is a common option

Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. In particular, if there are just one or two small bald patches then many doctors would advise that you simply leave it alone at first. This is sometimes called ‘watchful waiting’. If the hair loss is not too bad then there is a good chance that hair will re-grow after several months. (Any re-growth usually does not start within three months of hair loss.) A change in hair style may perhaps conceal one or two small bald patches. If the hair loss becomes more extensive, then the decision on whether to treat can be reconsidered. But even with extensive hair loss, there is still a chance that hair will re-grow without treatment.

Note: alopecia areata itself won’t damage your general health and so not treating will not lead to any general health problems. When deciding on whether to treat or not, you should take into account the possible side-effects that some of the treatments may have. Also, treatments promote hair to re-grow and do not affect or ‘cure’ the underlying cause of the condition.

Steroid injections

Injections of steroid into the bald patches of the scalp suppresses the local immune reaction that occurs in alopecia areata. This can then allow the hair follicles to function normally again and for hair to re-grow. This treatment may be an option for one or more small to medium sized bald patches. Steroid injections are thought to be the most effective treatment for patches of alopecia areata that are not too big. However, they do not work in every case.

This treatment is usually only done by a skin specialist and so you will usually need to be referred to hospital for it. Several injections (about 1 cm apart) are usually given at each session of treatment but the number is often limited by pain. Therefore, large bald areas are not suitable for steroid injections. Initial re-growth takes 1-2 months and injections are repeated every 4-6 weeks.

Do you have Hair Loss Problems, read our Hair Loss Help

Alopecia Areata: Giovanni’s Story (We Prove The NHS And His GP Wrong) Hair Loss – Giovanni’s Story Part 3.

Giovanni came to us very depressed and completely disillusioned. He was suffering from alopecia areata, psoriasis, eczema and male pattern baldness due to age.

Giovanni came to us after his GP and the NHS had refused to advise him about any of his conditions because he was in his 70’s.

All his GP and the NHS had to do was to refer him to a trichologist.

Fortunately for Giovanni we had treated one of his close friends and he was pointed our way.

The rest is his story:

This is him over 2 years on from the start of treatment and still looking great.

For the rest of Giovanni’s photos through his recovery click on to: 

http://www.haircentre.co/alopecia-areata-johns-story/

Giovanni’s Letter to us on completion of treatment:

Dear Gary

Because of you I am a happy man. At our first consultation, as you know, I was very down and miserable. Being a man, I thought that my gradual hair loss was normal for someone of my age.

When you explained the reasons of my hair loss to me, because of your expertise in these matters, you helped to alleviate my fears of losing all my hair.

After a few visits I began to realise that what you told me would happen, did happen, even though I took some convincing.

The products that you gave me to reverse my condition were easy to use and I had no problems following your instructions.

The results have been remarkable. I am ecstatic and my confidence has returned. I now have a luxuriant head of hair and no longer feel it is necessary to wear a hat in public.

Thank you for your empathy and support.

Yours sincerely

Giovanni  – a very happy man.

PS: Please do not forget the photographs – my friends do not believe me.

Do you have Hair Loss Problems, read our Hair Loss Help