Definition: Alopecia Areata (from latin-regional pattern baldness) is reversible hair loss in certain body locations. It affects 1-3% of both sex.

The primary focus in 60% of cases starts on the scalp. Seems to be characteristic, oval or round and sharply limited. Loss of hair is complete, and the skin is smooth and no signs of inflammation. In the most serious cases hair fall out on lash.

Why? real cause unknown, assumptions:

• small inflammation zones, theeth, sinuses
• hormonal function disorder, psychological stress

Result: Appearance of circumscribed oval hairless areas in different size and location. Painless and easy pulling out hair is sign of illness progression. Oval hairless zones can appear on any part of the body covered with hair (legs,men’s beard, eyebrows…)

When whole scalp area is affected we use term ALOPECIA TOTALIS, when with scalp all others body parts affected we talk about ALOPECIA ARREATA UNIVERSALIS. It is divided to Male pattern baldness, Female patern baldness, Telogen Effluvium and Trichotillomania.

Alopecia areata

Prognosis: The illness is very complicated to treat. Very resistant to therapy, long term illness with frequent recidivism. But it is very rare for hair never to growth back. It can involve scalp, beard, or other hair-bearing skin. It is widely considered as an organ-specific autoimmune response (an activity of the immune system), but some suggest psychosomatic implications.

Who is affected?

This disease can have a profound impact on the lives of both children and adults. Its onset can be sudden, unpredictable and recurrent. It progresses as hair-follicles prematurely enter catagen, telogen and exogen.

There may be predisposition in families with a history of thyroid abnormality, eczema, asthma or high fever. Alopecia Areata can rapidly follow excessive, sudden or prolonged stress (mental or physical), post-surgery, direct physical or psychological injury, bereavement, financial crises and other human emotions inculcating the autonomic nervous system.

Body-chemistry abnormalities may also be implicated. Diagnosis and treatment of a patient with bald patches can be about offering psychological support. Bald patches can and often are misdiagnosed. The trichologist is usually consulted as a second opinion. Alopecia Areata mostly occurs in acute and mild, and rarely in chronic, severe form of disease where the hair falls over many years.

However, the malignant alopecia results in a complete loss of hair on the body in the very short time. Duration of initial progression of disease in 30% of cases is less than six months, in 50% less than one year, and in 70-80% of cases less than five years. Full recovery is absent in 20 – 30% of cases. The progression of the disease is unpredictable , and in the early stages of disease it is impossible to give corresponding prognosis.

OTHER ALOPECIA TYPES

Traction Alopecia

Tight braids and hair ponytails can pulled hard enough to get out. It arises from a bad haircut where the hair is taut and tense. For the best treatment it is best to choose a hairstyle that put less pressure on hair roots and avoid permanent, chronic damage.

Diffuse Alopecia

Idiopathic Diffuse Alopecia in women seems to be increasing. The cause is unknown. The disease is not expressed until 80% of the hair is lost, and it is manifested by diffuse thinning of the hair throughout the head. Secretion of testosterone is increased. In women affected by Diffuse Alopecia  neurotic reaction can be developed which can be compared with Cancerofobia. Possible causes are : Bulimia or Anorexia Nervosa, Low serum ferritin, serum iron or vitamin B12, Hyper / hypo thyroidism, Post fever (body temperature of 102.5 F. or above).

TREATMENT OPTIONS

Topical

• Corticosteroids under occlusions for couple weeks(Potency varies from 0.5% to 2.0%. Figures suggest a high response rate in prepubertal children but lower in adults (double-blinded study).
  Potential side effects include:folliculitis, localised eczema, skin thinning.
• Corticosteroids injected intravenously (sited as near as possible to the affected follicles. Injections may be administered using a ‘Pan-jet system’ – which although faster and less painful is unpopular with some. Positive results if achieved may be seen after 8 + weeks. Side effects: pain and possible atrophy at the injection site.)
• Triamcinolonacetonid combined with local anesthetic ( results are visible often after 6-7 week of treatment)
• Cignolin (to 1%), photochemotherapy combined with 0.15% meladine tincture (long therapy couple of months)
• Hair loss medicaments
• Hair loss serums
• Hair loss lotions

Systematic

• Corticosteroids (30-4mg per day)-Normally indicated for Alopecia Areata,Alopecia Totalis or Alopecia Universalis. This is administered as intramuscular injection or oral medication. Potential side effects include: hypertension, weight gain, acne, menstrual problems, migraine, stunted growth in children, osteoporosis. This is last resort treatment.success achieved in 20% of affected people
• Hair loss shampoos
• Hair loss vitamins