There are two main forms of this condition which vary by the extent of hair loss and require different types of alopecia areata treatment. The mild form is where less than 50% of the hair is lost from thinning patches on the scalp and the more severe condition where more than 50% up to 100% of the hair is lost.
When diagnosing alopecia areata it is useful to have some background information about the disease. Alopecia areata is known as an autoimmune condition that can be highly unpredictable and which affects about 1.7 % of the population. The body’s white blood cells attack the hair follicles resulting in a stop in growth. It usually starts with one or two small round bald patches on the scalp, but can develop into a complete loss of hair, both on the scalp (alopecia totalis) and body (alopecia universalis). It is not known what triggers such attacks, whether the trigger comes from within, or from outside such as in the form of a virus.
Recent research seems to show that some people have genetic markers that increase both their susceptibility to the condition and to its severity. One in five people with the condition will have a relative who is also affected. This is especially true in those who develop the condition before the age of 30. It is more common in families whose members also have conditions such as asthma, hay fever, eczema, thyroid disease, Addison’s disease, rheumatoid arthritis, lupus erythematosus, vitiligo, Addison’s disease or pernicious anaemia.
The condition occurs in people of all ages and races and can have huge psychological effects which are exacerbated by the fact that the public at large do no generally understand this condition. It is sudden in onset and can recur from time to time quite unpredictably.
There is no known cure for alopecia areata and hair loss is a side effect of the underlying disease. Current alopecia areata treatments therefore work by extensive stimulation of the hair follicles which needs to be continued for the duration of the disease.
The mild form of the disease is easier to treat and the most common form of treatment is to have monthly cortisone injections, injected directly into the bare scalp. These are usually quite painless giving a slight tingling sensation and have very few side effects such as minor skin depressions. This alopecia areata treatment is usually complimented with higher strength 5% topical minoxidil solution applied twice daily. Cortisone cream is sometimes used in combination with minoxidil for improved response and applied 30 minutes after the minoxidil application.
Another effective treatment is anthralin cream or ointment, a synthetic, tar-like substance widely used for psoriasis treatment. It is applied to the bare scalp once daily and as it can be a skin irritant is usually only left on for 30-60 minute periods then washed off. Successful treatments can stimulate new hair growth in eight to twelve weeks.
Extensive alopecia areata is much more difficult to treat and local injections of cortisone into the scalp are not that effective. In some cases cortisone pills are prescribed, these have a more powerful effect but there is a greater risk of side effects with extended use. In general they are not widely prescribed apart from to young healthy adults who may have higher tolerance levels for the drug. Topical minoxidil at 5% strength is still the most common alopecia areata treatment and effective even for extensive alopecia areata. Another method that is used frequently in Canada and Europe is known as topical immunotherapy. This uses the chemicals diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE) to induce an allergic rash in the scalp. To date topical immunotherapy has been show to be the most effective treatment for alopecia areata with 40% of patients regrowing hair after six months of treatment.
Sufferers of alopecia areata should not give up hope of a cure as there are many ongoing research projects are currently being undertaken. Some of the most promising involve gene therapy, stem cells research and hair follicle development and new alopecia areata treatments will continue to be made available.
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