An autoimmune disorder, in which the immune system attacks hair follicles which is where hair growth begins.

The damage to the follicle is usually not permanent. Most common in people younger than 20, but children and adults of any age may be affected Women and men are affected equally. Classified into different types according to area affected

Abnormality in the immune system that leads to autoimmunity presents as an anagen effluvium. Autoimmune inflammation around the hair follicle aborts hair growth. Biopsies of affected skin show immune lymphocytes penetrating into the hair bulb of the hair follicles Sometimes occur within family members.

People with alopecia areata may have a higher risk for:

Another autoimmune disease such as thyroid disease or vitiligo (patches of lighter skin appear) Asthma and allergies, mainly atopic dermatitis (more commonly called eczema) and hay fever (nasal allergies) Having relatives who have asthma, allergies, or an autoimmune disease such as type 1 diabetes

Patchy hair loss: The problem often begins with 1 or more coin-sized, round, smooth, bare patches where hair once was. You may first notice the problem when you see clumps of hair on your pillow or in the shower.

Exclamation mark hairs: Often a few short hairs occur in or at the edges of the bare spots. These hairs get narrower at the bottom, like an exclamation mark

Widespread hair loss: With time, some patients go bald. Some lose all their body hair, too. This is not common. Also uncommon is a band of hair loss at the back of the scalp.

Nail problems: Alopecia areata also can affect your fingernails and toenails. Nails can have tiny pinpoint dents (pitting). They also can have white spots or lines, be rough, lose their shine, or become thin and split. Rarely nails change shape or fall off.

Alopecia areata. Nails can have dents, white spots, and roughtness

The exact pathophysiology of alopecia areata remains unknown. The most widely accepted hypothesis is that alopecia areata is a T-cellmediated autoimmune condition that is most likely to occur in genetically predisposed individuals.

Three phases of the hair growth cycle exist: 1) Anagen= growth phase; 2) Catagen= degradation phase; 3)Telogen= resting phase. Periods of growth (anagen) between two and eight years are followed by a brief period, two to four weeks, in which the follicle is almost totally degraded (catagen) The resting phase (telogen) then begins and lasts two to four months. Shedding of the hair occurs only after the next growth cycle (anagen) begins and a new hair shaft begins to emerge.

Classic peribulbar swarm of bees inflammation in alopecia areata. Some eosinophils are present within the infiltrate. (Hematoxylineosin stain; original magnification: 20.)
Abnormal hair shaft formation (trichomalacia): a sign of active alopecia areata. (Hematoxylineosin stain; original magnification: 20.)

Catagen transformation in subacute alopecia areata. (Hematoxylineosin stain; original magnification: 20.)

Marked miniaturization: a feature of longstanding alopecia areata. (Hematoxylin eosin stain; original magnification: 4.)

Nanogen follicle (intermediate stage, between terminal and vellus anagen) is very typical of alopecia areata. (Hematoxylineosin stain; original magnification: 60.)

There are three types of alopecia areata; alopecia areata, alopecia areata totalis and alopecia areata universalis.

Alopecia areata, the most common variation of the autoimmune disease, presents itself as round, smooth patches of various sizes

Alopecia areata totalis presents itself as total loss of hair on the scalp

Alopecia areata universalis is the rarest form of alopecia areata and presents itself as the loss of hair over the entire scalp and body.

Looking at hair loss Microscopy Biopsy Blood test

There is no cure for alopecia areata. Hair often re-grows on its own Not treating is a common option Alopecia areata is a very unpredictable condition. In many cases, bald patches regrow 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.

Corticosteroids: This medicine suppresses the immune system. It can be given as shots, with the dermatologist injecting the medicine into the places with hair loss. Sometimes a patient gets a topical (applied to the skin) form of this medicine. It may be a cream, lotion, or ointment. The patient applies the medicine to the bare spots. Less often, patients take corticosteroid pills.

Minoxidil: A hair re-growth medicine, minoxidil 5%, may help some patients regrow their hair. Both children and adults can use it. Patients apply it twice a day to the scalp, brows, or beard. New hair may start to grow in about 3 months. Patients most often use this medicine with another treatment. Anthralin: This medicine alters the skins immune function. The patient applies a tarlike substance to the skin and leaves it on for 20 to 60 minutes. A dermatologist may call this short-contact therapy. After 20 to 60 minutes, the anthralin is washed off to avoid the skin from becoming irritated.

Diphencyprone (DPCP): This medicine is applied to the bald skin. It causes a small allergic reaction. When the reaction occurs, a patient has redness, swelling, and itching. Dermatologists believe this allergic reaction tricks the immune system, causing it to send white blood cells to the surface of the scalp. This fights the inflammation. It also prevents the hair follicles from going to sleep, and causing the hair loss. Other treatments: Patients often get more than 1 treatment at a time. A mix of 2 or more treatments often boosts success.

When a person has alopecia areata, the hair will start to re-grow when the body gets the right signals. Sometimes this happens without treatment. Even with treatment, new hair loss can occur. Everything depends on how the immune system reacts.

Re-growing hair:

How long it lasts:

Emotional toll

If your hair loss bothers you a lot, you may wish to join a support group.

Frequency in the United States Prevalence in the general population is 0.10.2%. The lifetime risk of developing alopecia areata is estimated to be 1.7%. Alopecia areata is responsible for 0.7-3% of patients seen by dermatologists. International Worldwide prevalence of alopecia areata is the same as that in the United States.

Mortality/Morbidity Alopecia areata by itself is not associated with higher rates of mortality. Statistically increased prevalence of other auto-immune disorders in affected individuals makes its effect on morbidity undetermined. It can cause emotional and psychosocial distress in affected individuals. Self-consciousness concerning personal appearance can become important. Addressing these issues with patients is important in helping them cope with the condition. Race All races are affected equally by alopecia areata; no increase in prevalence has been found in a particular ethnic group.

Sex Data concerning the sex ratio for alopecia areata vary slightly in the literature. In one study including 736 patients, a male-to-female ratio of 1:1 was reported.In another study on a smaller number of patients, a slight female preponderance was seen. Age Alopecia areata can occur at any age from birth to the late decades of life. Congenital cases have been reported. Peak incidence appears to occur from age 15-29 years. As many as 44% of people with alopecia areata have onset at younger than 20 years. Onset in patients older than 40 years is seen in less than 30% of patients with alopecia areata.