Alopecia areata
From Wikipedia, the free encyclopedia
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|---|---|
| Severe case of alopecia areata before becoming totalis | |
| ICD-10 | L63. |
| ICD-9 | 704.01 |
| OMIM | 104000 |
| DiseasesDB | 430 |
| MedlinePlus | 001450 |
| eMedicine | derm/14 |
Alopecia areata is a form of hair loss from areas of the body, usually from the scalp. Because it causes bald spots on the head especially in the first stages, it is sometimes called spot baldness. In 1–2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis).
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[edit] Types
- Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
- Alopecia areata multilocularis refers to multiple areas of hair loss.
- If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
- If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.
- The disease may also be limited only to the beard (Alopecia areata barbae).
- A possible condition called Diffuse alopecia areata may cause a person with mixed grey and dark hairs to lose all their dark hairs at once due to a psychological trauma, causing the patient's hair to appear to have turned white overnight.
[edit] Causes
Alopecia areata is thought to be an autoimmune disease in which the body mistakenly treats its hair follicles as foreign tissue and suppresses or stops hair growth. It is not contagious but may be hereditary—there are a few recorded cases of babies being born with congenital alopecia areata. Stress has not been proven to be a crucial factor, although this is still disputed.
[edit] Diagnosis
First symptoms are small, soft, bald patches which can take just about any shape but are most usually round. Initial presentation most commonly occurs in the late teenage years but can happen with people of all ages. It most often affects the scalp but may occur on any hair-bearing part of the body. There may be different skin areas with hair loss and regrowth in the same body at the same time. It also may go into remission for a time, or permanently. The longer the hair loss persists, the smaller the chance that it will grow back. Fingernails may be affected, especially in severe cases where various nail changes may appear, the most common of which would be pitting of the fingernails.
In the diagnosis of alopecia areata, exclusion of other treatable diseases that cause hair loss such as trichotillomania and tinea capitis is important. In trichotillomania, there may be patches of broken hair and there will not be the skin changes associated with alopecia areata.
Another presentation of the condition are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic 'exclamation point' appearance.
One diagnostic technique applied by medical professionals is to gently tug at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair. In healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp. In cases of Alopecia, hair will tend to pull out easier along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy. Professionals will usually remind patients that the hair that is pulled out would eventually fall naturally. The test is conducted only once to identify the condition and rule out a simple localized hairloss condition.
[edit] Treatment
If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. In cases where there is severe hair loss, there has been limited success treating alopecia areata with corticosteroids (intradermal, topical, or oral), other immune modulators, minoxidil, or phototherapy.
[edit] Prognosis
Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies and atopic dermal ailments and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions. They may also have aberrant nail formation because keratin forms both hair and nails.
Episodes of alopecia areata before puberty predispose one to recurrent episodes after puberty. Pitting of the fingernails can hint at a more severe or prolonged course.
Initial stages may be kept from increasing by applying topical corticosteroids. However, since the exact mechanisms are not ultimately understood, there is no known cure to date. Hair implants may help covering bald spots, but cannot guarantee satisfactory outcome, since the bald areas might expand. Wigs should be prescribed if patients, especially female patients, mention social discomfort.
[edit] Psychosocial issues
As stated above, the most notable symptoms regarding alopecia are psychosocial. Alopecia can be caused by psychological stress, and it can result from psychological stress. This can lead to complex reactions. In more severe cases, where there is little chance of hair regrowth, individuals need to learn to adapt to having the condition, rather than look for a cure. Individuals with severe psychosocial distress may experience social phobia, relationship problems, and generalised anxiety and depression. In some cases, as the loss of hair can lead to significant appearance changes (eg from loss of eyebrows and eyelashes) individuals can experience identity problems. There is currently little provision for psychological treatment for people with alopecia.
[edit] Notable people with the condition
- Margaret Baker
- Edith Bouvier Beale
- Humphrey Bogart
- Neve Campbell
- Gustavo Chacín
- Pierluigi Collina
- Sean Daley
- David Ferrie
- Harima Kenji
- Alan Khan
- Matt Lucas
- Scott Lundy
- Dave McPherson
- Gail Porter
- Christopher Reeve
- John D. Rockefeller
- Charlie Villanueva
- Rasheed Wallace
- Billy Zane
- Charlie Vittanueva
[edit] Alopecia areata in domestic animals
Alopecia areata has been documented as a rare condition in domestic pet dogs and in horses.
[edit] Further Reading
Hunt, N. & McHale, S. (2004). Coping with Alopecia. London: Sheldon Press.
