Alopecia areata totalis - Causes - Treatment

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What is alopecia areata totalis?
Totalis is an extensive form of alopecia areata (AA). Alopecia areata totalis causes complete loss of hair on the scalp.

AA. totalis is an autoimmune disorder wherein the body's immune mechanism mistakenly considers the hair follicles on the scalp as harmful foreign bodies and attacks them. It is a non contagious condition with no specific cause and no standard treatment. Nearly 5% of the persons affected by alopecia areata may have complete hair loss on the scalp and develop the totalis form.

Though it can affect people of all ages, young children and young adults are more prone. Young children affected by hair loss may develop AA. totalis condition when they grow up. From the start of the symptoms, it may take less than six months for losing all the scalp hair. It is also seen that the genetic predisposition is a major cause and contributing factor for developing AA. totalis. In many cases the problem may cause psychological effects such as depression and emotional distress.

Alopecia areata totalis

The symptoms first appear as patches of hair loss on the scalp. It progresses rapidly and spreads to entire scalp.

Causes of alopecia areata totalis

AA. totalis is believed to be T cell-mediated autoimmune disease affecting the hair follicles. Antigen-presenting dendritic cells, CD4+ helper T cells, cytotoxic CD8+ T cells and a few polymorphonuclear leukocytes are seen as perifollicular accumulation at the site of AA.totalis. Human leukocyte antigen DQ3 (DQB1*03), HLA DQ7 (DQB1*0301) and HLA DR4 (DRB1*0401) are often detected in AA. totalis and universalis patients.

Treatment of alopecia areata totalis

Immunosuppression of cytokines, Interleukin 2 (IL-2), Interleukin 1 alpha (IL-1 alpha) and interleukin 1 beta (IL-1 beta) which participate in the regulation of immune responses, inflammatory reactions and hematopoiesis, causes inhibitory effect on the development of AA. totalis.

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Topical steroids and intralesional steroid injections have proven to be unreliable treatments. Systemic steroids and PUVA ultraviolet light treatment have given mixed results. Immunotherapy has been the most successful treatment for AA. totalis. By applying low concentration of an allergen on the scalp, contact allergic dermatitis is induced. The resultant cascade of immunomodulation and immunosuppression lead to suppression of autoimmune activity and causes regrowth of hair.

Turban PUVASOL therapy?

L Sornakumar et al of Department of Dermatology, PSG Hospitals, Coimbatore, India, have reported two cases of AA. totalis treated with "turban psoralen with sunlight exposure (PUVASOL)". A solution of 1 ml of 8-methoxypsoralen (8-MOP) 1% diluted in 2 liters of water was prepared. A clean absorbent cotton cloth was soaked into the solution and then wrapped around the scalp for 5 minutes.

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The scalp application was repeated four times and later the patient was exposed to sunlight for 5-15 minutes. In six months there was almost complete regrowth of scalp hair. The method did not cause any systemic side effects encountered in PUVA treatment.

Coping with A. areata totalis

If you feel that you are developing patches of hair loss, it is necessary to consult a specialist or a dermatologist immediately. Immunohistochemical studies may be undertaken to consider the modalities for coping with it. Understanding the condition you are in and having insights into what to expect, you can take pro-active steps to lessen mental stress and face the situation boldly.

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Being in touch with people having similar affliction and joining online community of people afflicted with alopecia areata totalis will give a great boost to your morale and self-esteem.

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References:
1.L Sornakumar, C Shanmuga Sekar, CR Srinivas. Turban PUVASOL: An Effective Treatment in Alopecia Totalis. Int J Trichology. 2010 Jul-Dec; 2(2): 106–107. doi: 10.4103/0974-7753.77520.
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Current topic in natural skin care: Causes of alopecia areata totalis and its treatment.