LOPECIA AREATA

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What are the symptoms of alopecia areata?

The typical pattern is for one or more bald patches to appear on the scalp. These tend to be round in shape, and about the size of a large coin. They develop quite quickly. A relative, friend, or hairdresser may be the first person to notice the bald patch or patches. Apart from the bald patch or patches, the scalp usually looks healthy and there is no scarring. Occasionally, there is some mild redness, mild scaling, mild burning, or a slightly itchy feeling on the bald patches.
fairly extensive alopecia areata. The second picture shows an area of alopecia of the beard area.
When a bald patch first develops, it is difficult to predict how it will progress. The following are the main ways it may progress:
1. Quite often the bald patch or patches re-grow hair within a few months. If hair grows back, it may not have its usual colour at first and look grey or white for a while. The usual colour eventually returns after several months. 2. Sometimes one or more bald patches develop a few weeks after the first one. Sometimes the first bald patch is re-growing hair whilst a new bald patch is developing. It can then appear as if small bald patches rotate around different areas of the scalp over time. 3. Sometimes several small bald patches develop and merge into a larger bald area. 4. Patches of body hair, beard, eyebrows, or eyelashes may be affected in some cases. 5. Large bald patches develop in some people. Some people lose all their scalp hair. This is called alopecia totalis. 6. In a small number of cases, all scalp hair, body hair, beard, eyebrows, and eyelashes are lost. This is called alopecia universalis. 7. The nails are affected in about 1 in 5 cases and can become pitted or ridged.

What causes alopecia areata?

Alopecia areata is thought to be an autoimmune disease. The immune system makes white blood cells (lymphocytes) and antibodies to protect against foreign objects such as bacteria, viruses, and other germs. In autoimmune disease, the immune system mistakes part or parts of the body as foreign. In people with alopecia areata, many white blood cells gather around the affected hair roots (hair follicles) which are mistaken as foreign. This causes some mild inflammation which leads in some way to hairs becoming weak and falling out to cause the bald patches.
It is not known why it is common for only certain areas of the scalp to be affected. Also, the affected hair follicles are not destroyed. Affected hair follicles are capable of making normal hair again if the immune reaction goes and the situation returns to normal.
It is not known why alopecia areata or other autoimmune diseases occur. It is thought that something triggers the immune system to react against one or more of the body's own tissues. Possible triggers include: viruses, infection, medicines, or other environmental factors. There is also an inherited factor which makes some people more prone to autoimmune diseases. About 1 in 4 people with alopecia areata have a close relative who is also affected.
If you have alopecia areata you also have a slightly higher than average chance of developing other autoimmune diseases such as thyroid disorders, pernicious anaemia and vitiligo. (However, it is important to stress that most people with alopecia areata do not develop any of these other conditions.)

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 scraping 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.

What are the treatment options for alopecia areata?

Not treating is a common option
Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. In particular, if there are just one or two small bald patches then many doctors would advise that you simply leave it alone at first. This is sometimes called watchful waiting.
If the hair loss is not too bad then there is a good chance that your hair will re-grow after several months. (Any re-growth usually does not start within three months of hair loss.) A change in hairstyle may perhaps conceal one or two small bald patches. If the hair loss becomes more extensive, then the decision on whether to treat can be reconsidered. But even with extensive hair loss, there is still a chance that hair will re-grow without treatment.
Note: alopecia areata itself won't damage your general health and so not treating will not lead to any general health problems. When considering any treatment choices, you should take into account the possible side-effects that some of the treatments may have. Also, treatments promote hair to re-grow and do not affect or cure the underlying cause of the condition.

A final note about treatments

As you can see from the section above, there are various treatment options. It is difficult to say from the outset whether a particular treatment will benefit a particular person. One of the difficulties is that hair grows back without any treatment in many cases. Therefore, it is difficult to research the effect of treatments, as hair may re-grow naturally.
Generally, the success rate for the various treatments is probably not high. Also, there is no guarantee that any hair re-grown during treatment will persist once the treatment is finished.

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