Alopecia Treatment - Alopecia Areata

Alopecia, more commonly known as hair loss, typically occurs on the scalp; hair loss elsewhere on the body is less common and less conspicuous. In the nonscarring form of this disorder (noncicatricial alopecia), the hair follicle can generally regrow hair. Scarring alopecia usually destroys the hair follicle, making hair loss irreversible.

The most common form of nonscarring alopecia is male-pattern alopecia. Female-pattern alopecia involves diffuse thinning over the top of the scalp. Genetic predisposition commonly influences the time of onset, the degree of baldness, the speed with which it spreads, and the pattern of hair loss.

Other forms of nonscarring alopecia include:

• telogen effluvium, a diffuse alopecia in which numerous hair follicles simultaneously change from the growing anagen phase to the resting telogen phase of the hair growth cycle
• alopecia areata (idiopathic form), a generally reversible and self-limiting disorder most prevalent in young and middle-aged adults of both sexes
• trichotillomania, the compulsive pulling out of one's own hair, most commonly found in children and adolescents.

Causes

Male-pattern alopecia appears to be related to androgen levels and to aging. Predisposing factors of nonscarring alopecia also include radiation, chemotherapy, many types of drug therapies and drug reactions, bacterial and fungal infections, psoriasis, seborrhea, and endocrine disorders, such as thyroid, parathyroid, and pituitary dysfunctions.

Excessive vitamin A can also cause alopecia. Telogen effluvium occurs after childbirth, crash diets (inadequate protein), surgery, severe illness, and high fever.

Scarring alopecia may result from physical or chemical trauma, radiation or chemotherapy, or chronic tension on a hair shaft, such as braiding or rolling the hair. Diseases that produce scarring alopecia include destructive skin tumors, granulomas, lupus erythematosus, scleroderma, follicular lichen planus, and severe bacterial or viral infections, such as folliculitis and herpes simplex.

Symptoms

Alopecia areata results in smooth, round or oval bald areas. There are usually no signs of inflammation. Symptoms can vary from bald patches (patchy alopecia areata), to complete scalp baldness (alopecia totalis), to loss of all scalp and body hair (alopecia universalis). People with this condition are otherwise in generally good health.

Diagnostic tests

Dermatologists are skilled in diagnosis by sight alone. For more obscure diseases, they may have to resort to a skin biopsy , removing a tiny bit of skin using a local anesthetic so that it can examined under a microscope. Systemic diseases will require a complete evaluation by a physician, including specific tests to identify and characterize the problem.

Treatment

Topical application of minoxidil has limited success in treating male-pattern and female-pattern alopecia, but it's unsuccessful in alopecia areata. Oral finasteride (Propecia) yields better results in both hair retention and new hair growth for some individuals. An alternate treatment is surgical redistribution of hair follicles by autografting.

Patients with alopecia areata may be treated with topical corticosteroids, such as betamethasone dipropionate, halcinonide, and triamcinolone acetonide, or by intralesional injections, which may help to stimulate hair growth if hair loss is confined to small patches; this therapy may produce regrowth in 4 to 6 weeks. Hair loss that persists for more than 1 year has a poor prognosis for regrowth.

Other drug therapy may include photochemotherapy with methoxsalen and ultraviolet light, dermatomucosal agents such as anthralin, antibiotics for bacterial infections, and antifungal agents for fungal infections.

Chemotherapy patients may benefit from procedures that reduce the blood supply to the scalp and there by preserve more hair structure. These procedures - cold cap application and scalp tourniquet­aren't appropriate for patients with leukemia, lymphoma, or highly metastatic tumors because cancer drugs must be allowed to perfuse the scalp area to irradiate these neoplastic cells.

For some patients, hair transplantation and tunnel grafting or cosmetic interventions (hairpieces, weaving, or bonding) are beneficial.

Telogen effluvium resolves spontaneously over 6 to 12 months.

In trichotillomania, an occlusive dressing promotes normal hair growth by protecting the site of hair loss. The treatment for other types of alopecia varies according to the underlying cause.

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