Understanding Alopecia Areata: Symptoms, Diagnosis, and Treatment Options
Doctor explains the causes, symptoms, and treatment options for alopecia areata, a common hair loss condition. Discover who is affected, how it's diagnosed, and when to seek specialist care.
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Topic Breakdown
Alopecia areata is a chronic inflammatory condition that affects the hair follicles, leading to sudden onset of non-scarring hair loss. Unlike other forms of alopecia, the hair follicles are generally preserved. In the UK, this condition is relatively common, affecting approximately 15 in every 10,000 people. Today, we’ll delve into who is affected by alopecia areata, its signs and symptoms, how it's diagnosed, treatment options, prognosis, and when to refer a patient to a specialist for further assessment.
Alopecia areata can manifest at any age and affects both males and females equally. Any hair-bearing skin can be involved, but it most commonly impacts the scalp or the beard, and less frequently the eyebrows and eyelashes. Total loss of scalp hair, known as alopecia totalis, or scalp and body hair, known as alopecia universalis, is rare.
The signs and symptoms of alopecia areata can vary. Most patients experience no symptoms and discover a bald patch or thinning hair incidentally, often noticed by a hairdresser. Some patients might describe a burning or prickly discomfort in the affected areas, a sensation known as trichodinia.
There are different subtypes of alopecia areata, which we’ll briefly discuss. The most common type is patchy alopecia areata, where patches of hair loss can affect any hair-bearing area but most often the scalp, eyebrows, eyelashes, and beard. Patchy alopecia areata progresses through three stages: sudden loss of hair, enlargement of the bald patch or patches, and regrowth of hair. The bald areas may have a smooth surface completely devoid of hair or feature scattered exclamation mark hairs. These hallmark hairs are two to three millimeters in length, broken or tapered with club-shaped roots. Microscopy of these hairs shows a thin proximal shaft and a normal caliber distal shaft.
Alopecia totalis affects up to five percent of patients with autoimmune hair loss, leading to the loss of all or nearly all scalp hair. Alopecia universalis affects less than one percent of cases and results in the loss of all hair on the body. Nail changes are also common, seen in around 10 to 15 percent of patients with alopecia areata. The most frequent nail abnormality is regular pitting and ridging, although other nail signs can also be observed.
Diagnosing alopecia areata is typically done clinically. Once a doctor has assessed you, they can usually make the diagnosis based on your history and examination.
When assessing a person with suspected alopecia areata, it's essential to take a comprehensive history. This includes asking how the hair loss is affecting the patient, any known triggers such as emotional or physical stress, their coping strategies, and support network. Remember, alopecia can have a significant psychological impact on the patient. Inquire about any previous episodes of hair loss, current or past treatments and their effectiveness, family history of hair loss, or any family history of atopy or autoimmune disease. Ensure you examine the patient, especially the skin, for signs of scarring or inflammation which may suggest an alternative diagnosis.
Moving on to the management and treatment of alopecia areata, the first step is to provide advice on the natural history of the condition and offer a range of treatment options depending on the severity of the alopecia. If there is evidence of hair regrowth or less than 50 percent hair loss, a three-month trial of a potent or very potent topical corticosteroid treatment can be considered. For those with no hair regrowth or more than 50 percent hair loss, cosmetic options to camouflage hair loss, such as hair extensions, dermal tattooing, or false eyelashes, can be offered. The option to wear headpieces or wigs can also be considered if appropriate. Psychological support should be provided if needed.
The prognosis of alopecia areata is unpredictable. Spontaneous remission within one year may occur in up to 80 percent of people with limited patches of hair loss or hair loss of less than one year in duration. Therefore, it’s crucial to ask about the duration of the alopecia.
Referral to a pediatric dermatologist or a dermatologist should be arranged if the person has hair loss that isn’t responding to treatment in primary care, if treatment is declined, if the diagnosis is uncertain, or if the patient is a child, pregnant, or a breastfeeding woman.
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