What is alopecia areata - Definition of alopecia areata

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What is alopecia areata?
Alopecia areata is the medical term for sudden transient loss of hair in circumscribed patches especially of the scalp or face.

Initially alopecia areata patches may appear round or oval with the marginal broken hairs having a typical exclamation point or '!' appearance. Though the exact cause is not clear, research evidence suggest an autoimmune origin.

This disorder is also found to run in families and affects 1.7% of the population at some point in their lives. Alopecia areata is also found to be associated with some autoimmune diseases and hereditary disorders. Intense emotional state of stress, anxiety and panic are common triggering and precipitating factors.

Both men and women may be affected by this type of alopecia. In men beard area may also be involved. Children and young adults are affected more often than other age groups. Spontaneous remission and recurrence of alopecia areata is common. In some cases the condition may be progressive and result in total hair loss on the head and body.

Definition of alopecia areata

Spot baldness

National Library of Medicine definition: "Alopecia areata is a condition that causes round patches of hair loss. It can lead to total hair loss."

Medterms.com definition: "Alopecia areata: Patchy baldness that typically begins with rapid hair loss on discrete areas of the scalp and sometimes progresses to complete baldness and even loss of body hair."

Merriam-webster.com definition: "sudden loss of hair especially of the scalp or face in circumscribed patches with little or no inflammation."

What are the types of alopecia areata?

These patches of hair loss are categorized into subtypes considering the extent of hair loss as well as the affected areas.

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Alopecia totalis
In some individuals the hairless patches may grow leading to total loss of hair on the scalp in about six months. The condition may become permanent is some individuals whereas in some hair may grow back completely.

Alopecia universalis
In AA universalis, hair loss may spread to entire epidermis causing total loss of scalp and body hair. The condition may become permanent is some individuals whereas in some hair may grow back completely.

Alopecia incognita (diffuse alopecia areata)
AA incognita is a very rare type of hair loss with rapid progress, found mostly in young women. The disorder is clinically different from other types as it is diffuse and is lacking in well-defined patches.

Alopecia barbae
Noninflammatory hair loss in sharply defined areas on the chin is known as alopecia barbae. These patches may appear along with patches on the scalp or appear only on the beard area.

What are alopecia areata causes?

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In AA with autoimmune origin the body's immune system mistakenly attacks the hair follicles causing hair loss. There is association of the disorder with other autoimmune diseases like autoimmune thyroiditis, diabetes mellitus, vitiligo, rheumatoid arthritis and psoriasis. Some people have the disorder running in their families. In such cases having genetic predisposition certain triggers like severe viral infection, severe stress, panic or anxiety may precipitate hair loss. Certain environmental factors may also play a major role in the etiopathogenesis. Nutritional deficiency, especially iron or zinc deficiency is reported to precipitate the hair loss.

What are alopecia areata symptoms?

Sudden loss of hair in round or oval patches is the only symptom. Usually, the hair loss occurs on the scalp. It may also occur on the hairy parts of the body. In very rare cases well-defined linear hair loss is seen. Broken hairs at the edge of the patch may look like exclamation points. In rare instances burning sensation or itching had been reported. Nail pitting, multiple leukonychia and trachyonychia are observed in 30-50% of the cases of alopecia areata.

Alopecia areata treatment and management

There is no cure for this disorder. Corticosteroids are the preferred medication in the treatment of this disorder. They may be administered in oral, topical or intralesional preparations.
Minoxidil, an antihypertensive vasodilator medication, is found to arrest hair loss and stimulate hair growth.
Anthralin (dithranol) a synthetic oxidative immunosuppressive compound with anti-psoriatic action is used successfully with short contact treatment. It may have side effects like severe irritation and folliculitis.
Other forms of treatment for alopecia areata include topical immunotherapy, phototherapy, use of prostaglandin analogues, use of topical calcineurin inhibitors, Sulfasalazine use and mesotherapy.

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References: 1.Deepak SH, Shwetha S. Scalp roller therapy in resistant alopecia areata. J Cutan Aesthet Surg 2014;7:61-2
2.Seetharam KA. Alopecia areata: An update. Indian J Dermatol Venereol Leprol 2013;79:563-75
Current topic in natural skin care: What is alopecia areata and its definition.