The Different Types of Autoimmune Alopecia

Due to the media's frequent mis-use of the term 'alopecia', it can be confusing for people to understand the difference between hair loss conditions such as male pattern baldness, and sudden hair fall that is caused by autoimmune disorders.

Autoimmune hair loss encompasses a band of disorders which cause baldness in a range of severities, and can all affect men, women and children of all ages and races. Together they come under the umbrella of Alopecia Areata, though each version has its own distinct symptoms and names.

The exact cause of each of these is currently unknown, but what researchers do know is that there are a number of provocateurs which are believed to be able to trigger alopecia areata. These include extreme shock, trauma, chronic stress, hormonal changes such as pregnancy or IVF, and genetic factors. Recent research has likened alopecia areata to 'diabetes of the hair follicle', whilst links between vitamin D and alopecia areata appear fairly regularly in studies hoping to pinpoint the disorders' actual cause.

Hair falls out when whatever the underlying trigger is causes the body's immune system to turn on itself, shocking the hair growth cycle and leaving various follicles stuck in its resting - Telogen - phase. Whilst little is known about its actual pathogenesis, all forms of Alopecia Areata are believed to share the same triggers.

Here we explain the four most common types of alopecia areata which, although their precise bio-mechanisms remain fairly mysterious, they are all considered autoimmune hair loss disorders.

Alopecia Areata: patchy hair loss from the scalp only

This is the most common form of autoimmune hair loss and, despite being used to refer to the group of conditions, also refers specifically to the most moderate form of the disorder.

Alopecia areta is characterised by rounded bald spots which can appear anywhere on the scalp. These can be as small as a £1 coin or far larger, and there may be a single bald patch or many, sometimes even joining up to cause larger areas of hair loss. The hair fall presents suddenly, as opposed to the gradual thinning which is seen in cases of the more common androgenetic alopecia.

Whilst, for many, normal hair growth should resume within 12 months, this is not the case for everyone. Frustratingly for those affected, on top of not knowing the exact cause of the disorder, if or when regrowth may occur is also unknown and cannot be predicted. Furthermore, in some instances, even if the hair grows back satisfactorily, alopecia areata can recur at a later date.

Alopecia Totalis: baldness of the head, including scalp and facial hair

Whereas Alopecia Areata causes circular bald patches on the scalp, Alopecia Totalis causes sudden hair fall from the head. This leaves the scalp totally bald, with a smooth, shiny appearance. Frequently it will also lead to facial hair, including eyebrows and eyelashes, falling out too.

Alopecia Universalis: complete baldness from head to toe

is the most extreme type of alopecia areata. It goes a step further than Alopecia Totalis by causing total baldness all over the head and body, leaving the person completely hair-free. It can also cause changes to the nails, which may become brittle and show signs of pitting and/or ridges. Whilst Alopecia Universalis is understood to be the result of a genetic mutation that means the condition is present from birth, it may take many years to become active.

Ophiasic Alopecia: a band of baldness encircling the hairline

This form of autoimmune alopecia is similar to Alopecia Totalis, in that it leaves behind a hair-free area of smooth, shiny skin and only affects the head. However, it takes a different shape. Named after the greek word for 'snake', Ophiasic Alopecia presents as a thick band of baldness which encompasses the front, back and sides of the hairline. It is also known as Ophiasic Areata and Ophiasic Alopecia Areata.

Alopecia Barbae: rounded bald patches in the beard

Although Alopecia Barbae causes rounded bald spots to the beard only, it can present alongside Alopecia Areata too. The bald patches - singular or multiple - this causes are known as 'herald patches' and may potentially indicate that the condition may spread. Alopecia Barbae - also known as Alopecia Areata Barbae - may also appear in addition to other hair loss conditions. The most common of these is Male Pattern Baldness, which can be identified by thinning hair on the top of the head, either along the vertex, at the crown, forming a receding hairline, or in any combination of these patterns.

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Treatments for Alopecia Areata

Currently hair loss from three of the above disorders can be treated. These are Alopecia Areata, Ophiasis and Barbae.

There are currently no truly effective hair loss solutions for Alopecia Totalis and Universalis, though researchers are avidly working on this and hope to have the first treatments ready to release in 2020/2021, assuming the necessary approvals and clearances are granted by the relevant medical regulators. In the meantime and, especially when children are concerned, there are a number of extremely supportive hair loss charities whose resources include everything from free wigs to local support groups.

Cases of alopecia barbae are generally dealt with by a dermatologist, given they are on the face, but specialist hair loss clinics can offer treatment for both areata and ophiasic alopecia.

At Belgravia, custom courses of Alopecia Areata treatment tend to focus primarily on recommended formulations of high strength minoxidil. This is generally paired with additional hair growth boosters to complement the action of this treatment.

The minoxidil is applied directly to the areas where it is needed, either once or twice per day as instructed. This then opens the potassium channels to stimulate localised hair growth.

In our experience, regrowth from Alopecia Areata often takes around six months, depending on its severity. Shorter or longer recovery times have certainly been witnessed among Belgravia clients, though Ophiasic Alopecia does generally take longer than this. This is because it is a more stubborn form of hair loss that requires more attention.