Alopecia is the pathological loss of hair connected with hormonal disorders, physical or emotional overloads, hereditary predisposition, etc.
Causes of Alopecia Areata
There are several different hypotheses as to what causes alopecia areata. Genetic factors seem to play an important role since there is a higher frequency of a family history of alopecia areata in people who are affected. Alopecia areata appears to also have an autoimmune factor causing the patient to develop antibodies to different hair follicle structures.
Congenital alopecia, or hair loss, is relatively rare. It is characterized by full absence or drastic thinning of hair that can be combined with other disorders such as deterioration of nails,teeth, etc. Premature, or presenile, alopecia occurs most often among young and middle-aged men and develops gradually. In case with women it is generally limited to hair thinning. Hair loss begins in frontal and parietal areas. Then process grasps other sites of the scalp. The head-skin on the bald sites becomes thin, smooth and brilliant, and apertures of hair follicles are imperceptible.
Seborrheic alopecia, as the name prompts, develops on the background of seborrhea. It is marked with abnormal sebaceous excretions and thinning of hair on the whole surface of the scalp, its peeling, and increased greasiness of hair.
Cicatricial alopecia presupposes constant destruction of hair follicles and their replacement by connecting tissue. Cicatrices usually are not so visible as in case of healing wounds. They result in disappearance of apertures of hair follicles and the scalp becomes smooth and brilliant. The skin can remain soft and elastic though sometimes there may be callosities.
Areal alopecia, or alopecia areata, is characterized by loss of hair in one or several small sites on the scalp, underarms, on the pubis, beard, eyelashes or eyebrowes. Such hair loss areas have more often round outlines, they can increase and merge among themselves, forming larger sites. The skin in the new-forming centers is slightly hyperemic and edematic. Later on it becomes smooth and gets the color of ivory.
Disease can proceed on the background of eosinophilia, lymphocytosis, regional lymphadenitis, thinning of nails, accompanied by headaches. In some cases total loss of hair on the head, and also loss of eyelashes, eyebrowes, and lanugo (malignant, or universal alopecia) is marked. Hair can drop out during several years. Hair loss process can differ in intensity and duration. Sometimes children can have alopecia by way of small-focal “gleams” of hair or the coiled nimbus extending ribbonly from the nape to the auricles.
Most often therapy of premature alopecia consists in intensive bracing treatment. It can’t result in restoration of all lost hair on the scalp, but it can reduce appreciablly the process of hair loss. Now techniques of operative treatment of hair loss, or alopecia, are developed. For example, hair transplantation in bald spots. This operation is carried out in specialized clinics and is rather expensive.
Do I need any tests?
Usually not. The diagnosis is usually based on the typical appearance of the bald patches. If there is doubt about the cause of the hair loss, sometimes some blood tests or a skin scrapping from a bald patch may be done to rule out other causes of baldness. A small skin biopsy (small sample) is sometimes taken to look at under the microscope.
Hair losing women with hyperandrogenism are usually treated to eliminate the causes of the latter. In case of increased sensitivity to androgenes (male hormones) the nonspecific therapy that reduces their production by ovaries or blocks their peripheral effects is carried out. With this purpose oral contraceptives and spironolactone are applied.
Treatment symptomatic alopecia should be directed on the basic disease. In case of favorable outcome hair are restored and regrown in due course.
Treatment of seborrheic alopecia should be preventive. In these purposes besides bracing therapies and correction of metabolic processes intensive topical treatment is used. Complex treatment can warn or suspend loss of hair. Such therapy is carried out by dermatologists and cosmeticians.
Minoxidil has been used to promote hair growth and has shown cosmetically acceptable results in 30% of cases. Minoxidil does not stop the disease process so stopping applications after hair has started to grow back may cause the hair to fall out again.
Another type of treatment is designed to produce a contact dermatitis, or irritation, at the site seemingly stimulating hair growth. The most common irritant used is called anthralin. Some studies suggest using minoxidil and anthralin in combination may be more effective.