Alopecia areata
Alopecia
areata (AA) is the patchy loss of hair on the scalp or body. It can occur at
any age and affects 1% of the population, most commonly children. The reasons
for its development are not fully understood. Although not life threatening,
the hair loss can be psychologically traumatic.
Scientists
think AA is an autoimmune disease where white blood cells from the immune
system attack hair follicles and keep them from producing hairs. Autoimmune
disease occurs when a patient's immune system mistakenly thinks that part of
his or her own tissue is diseased. The tissue is then attacked. The end result
depends on how effectively the tissue defends itself as it tries to grow back
normally.
Usually,
dermatologists diagnose AA by close examination of the scalp, and considering,
then eliminating other hair loss causes. Typical AA starts as a smooth bald
patch that suddenly appears. Some people feel a tingling sensation or very mild
pain in the affected area. The scalp is the most commonly noticed area, but AA
can form anywhere on the body: eyelashes, armpits, leg hairs, etc.
AA spreads
out on the edges as it grows, with the hairs on the edges thinning out at the
roots until they fall out. The stubble left at the edge is thin at the bottom
and is said to look like an exclamation mark (!). As long as hair can be easily
pulled out, the AA is active and further hair loss should be expected. More
hair in the comb means more spots.
Not all cases
are obvious, and in these the dermatologist must take a small skin biopsy plug
(a small piece of skin less than a 1/4 inch in diameter) for microscopic
examination. Habitual hair pulling (trichotillomania), scalp fungus (black-dot
ringworm) and other skin diseases (lichen planopilaris, cutaneous lupus and
telogen effluvium) cause the most confusion.
Most cases
that start with a few patches last a few months to a year and normal hair
growth quickly resumes. If there are more than a few small patches of hair
loss, it may also grow back or develop into total scalp hair loss (alopecia
totalis) or even complete body hair loss (alopecia universalis), although this
is rare. Severe disease has less of a tendency to resolve on its own,
especially in children or atopic (prone to allergy) individuals.
AA is unpredictable,
and repeated episodes are not unusual. Some cases last many years with some
regrowth in one area, while at the same time new areas appearing. AA may also
cycle through expression and remission. When hair does start to regrow, it
tends to be of very fine "peach fuzz" hair, eventually regaining most
or all of its normal color and texture.
There is no
actual loss of hair follicles (i.e. the "root") even in the hairless
lesions. The follicles are not producing visible hairs because of the attacking
white cells that surround the root. Hair follicles are capable of taking a lot
of punishment. Despite the attack by immune cells the hair follicles usually
remain capable of re-growing even after years of attack. However in severe
cases this becomes less and less likely as years pass.
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