Do We Treat Alopecia Areata and How Successful is Treatment?
Yes. Alopecia Areata is a condition that is seen frequently by our hair loss specialists. Depending on the severity of the condition and the stage it has reached, treatment for Alopecia Areata can be very successful. As you can see in our patient images, patches of Alopecia Areata will frequently be cleared up by treatment. It is once a fair amount or all hair on the head or body has been lost due to Alopecia Areata that treatment begins to be less hopeful.
Many Doctors recommend steroid injections which involve multiple injections to the scalp and can be uncomfortable and painful. The Belgravia Centre offers a range of high strength minoxidil products which we have found to be very effective in the treatment of alopecia as can be seen by our photo-scans.
We are unable to treat Alopecia Areata of any other parts of the body including the face. If this is the case for you please contact your GP. We also recommend people under the age of 16 with Alopecia Areata to contact their GP.
What is Alopecia Areata?
Alopecia areata is characterised by sudden patchy loss of hair, which is due to many follicles prematurely and rapidly entering the telogen (resting) phase. The cause of Alopecia Areata is unknown but this type of Alopecia falls into the category of autoimmune disorders. Alopecia Areata is relatively common and can affect as many as one person in a thousand at some time in their life. Occasionally Alopecia areata becomes very widespread and severe and develops into Alopecia Totalis or Alopecia Universalis. Alopecia Areata is considered by some to have an autoimmune mechanism but there may be an external trigger such as a sudden shock or extreme stress.
What are the Initiating Factors for Alopecia Areata?
We do not know what activates and promotes the onset of Alopecia Areata hair loss. There are several suggested factors that may influence the course of Alopecia Areata.
1. Psychological long-term chronic stress
2. Shock and sudden extreme stress
3. Physical trauma
4. Local skin injury
5. Genetic predisposition
6. Viral/bacterial infection
10. Seasonal changes
Alopecia Areata and Psychological Long-Term Chronic Stress
A wealth of case-lore suggests that stress is an important precipitating factor in Alopecia Areata. Various reports tentatively support the stress hypothesis but so far it has only been shown by statistical correlation (Muller 1963, De Weert 1984, Perini 1984, De Waard Van der Spek 1989) – no direct physical link has been demonstrated. Indeed, some investigators refute stress being significant in Alopecia Areata (MacAlpine 1958).
One of the problems with defining the significance of some journal reports on stress and Alopecia Areata is the lack control groups for direct comparison and evaluation. Further, the subsequent stress as a result of hair loss can confuse the issue in these inevitably retrospective studies. Stress is suggested as an environmental trigger in people predisposed to Alopecia Areata development (due to genetic susceptibility for example) rather than the primary basis for Alopecia Areata development (Muller 1963).
Alopecia Areata and Shock, or Sudden Extreme Stress
There have been a number of reports on individual cases where clearly defined sudden stress events have preceded Alopecia Areata development. The emotional trauma of a family death, or being involved in a car accident without major injury, has been suggested as triggers for Alopecia Areata onset.
Alopecia Areata and Physical Trauma
There is a reasonable amount of case history evidence to show that physical trauma can trigger the onset of Alopecia Areata. Anything that stimulates the immune system from being hit on the head to an infection can be a potential trigger.
Only recently has there been a demonstration of a tangible link between trauma and autoimmune diseases. Cells under physical stress can produce heat shock proteins (HSPs). As the name suggests HSPs are produced when cells are given heat shock. It has recently been found that cells also produce these proteins after exposure to other forms of stress such as inflammation, fever, irradiation, viral infection, malignancy, oxidation, heavy metals etc. The HSPs play a housekeeping role in immune system responses. These proteins have been implicated in the autoimmune diseases Rheumatoid Arthritis, Lupus, and Ankylosing Spondylitis and Alopecia Areata.
Alopecia Areata and Localised Skin Injury
Cuts, scrapes, and other abrasions of normal haired skin are often the focus for the onset of a new patch of hair loss in Alopecia Areata susceptible people. Ironically, similar abrasions in areas of skin already affected by Alopecia Areata can be the focus of temporary hair regrowth. Injury is known to promote anagen hair follicle growth in skin immediately surrounding the injured site.
Alopecia Areata and Genetic Predisposition
It has been shown that there is a higher incidence of Alopecia Areata occurring in genetically related individuals. This suggests that at least some people are genetically predisposed towards the development of Alopecia Areata. Several research groups have been examining the genetic make up of people who develop Alopecia Areata and found some genes to be much more common in people with Alopecia Areata compared to the general population.
It is generally believed that Alopecia Areata susceptibility is polygenic – there are a number of genes that, if present, make that individual more likely to develop Alopecia Areata. The triggers for the actual onset of Alopecia Areata are most likely environmental but susceptibility to development of Alopecia Areata, the resistance of the Alopecia Areata lesion to treatment, and its persistence and regression and its extent over the body might be influenced by the presence and interaction of several genes.
Alopecia Areata and Viral/Bacterial Infection
Cytomegalovirus infection of hair follicles has been implicated by at least one research group in development of Alopecia Areata (Skinner 1995). However, research by other groups has failed to confirm the potential link (Garcia-Hernandez 1998, Tosti 1996). HIV infection has also been suggested as a potential trigger for Alopecia Areata onset (Piras 1997, Grossman 1996, Cho 1995, Stewart 1993). Other trichologists suggest general viral/bacterial infections may promote the immune system into an inappropriate response against hair follicles in susceptible people.
Alopecia Areata and Pregnancy/Hormones
The apparent link between hormonal fluctuations and Alopecia Areata has been recognized for some time (Sabouraud 1896, Sabouraud 1913). Most notable are the cases of Alopecia onset during late stage pregnancy. Women who already have Alopecia Areata can find that they have complete but temporary hair regrowth around the time of childbirth (Walker 1950). Puberty and menopause have also been suggested as a time of potential Alopecia Areata onset or remission.
Alopecia Areata and Allergies
Statistical analysis shows that Caucasians with Alopecia Areata and some form of atopy (Asthma, eczema, rhinitis) are inclined to have hair loss that is more extensive and/or of prolonged duration (Muller 1963, De Waard Van der Spek 1989). Interestingly, statistical analysis of Indians with Alopecia Areata showed no such link (Sharma 1996). This may suggest that the different genetic composition of different races must be taken into account when explaining susceptibility to Alopecia Areata development.
Alopecia Areata and Chemicals
One “outbreak” of Alopecia Areata in workers at a water treatment plant in a paper factory was linked to long term exposure to the chemical acrylamide (Roselino 1996). Formaldehyde and pesticides have also been suggested, although not proven, as a potential influence in the development of Alopecia Areata. Isolated case reports have suggested a link between Alopecia Areata development and Zidovudine treatment of HIV (Geletko 1996), and Fluvoxamine anti-depressive treatment (Parameshwar 1996).
Alopecia Areata and Seasonal Changes
A significant number of people with Alopecia Areata find the extent of the hair loss cycles in time with the seasons. Some people find the hair loss is much more extensive in winter and have temporary, partial regrowth in summer.
Whatever the initiation factor, it need not be permanent – rather a short sharp shock may be just enough to tip the balance of the immune system into autoimmunity. Once an autoimmune disease is initiated it can be self-perpetuating. Tissue destroyed in the early stages of the disease can be broken down and the antigens presented to immune system cells in the lymph nodes. This recruits more self- reactive cells, which destroy more tissue producing more antigens and so the cycle continues.