Alopecia is a common form of hair loss. Celebrities like Jada Pinkett Smith have been vocal about their own journey of dealing with alopecia. This condition has various causes, and manifests in different types. The most common form of alopecia is alopecia areata, an autoimmune disease.
While alopecia areata may not have a cure, it could be treated with the right methods. This article discusses the causes of alopecia areata, the right treatment options, and ways you may possibly prevent it.
In This Article
What Is Alopecia Areata?
Alopecia areata is an autoimmune disorder that affects about 25% of the general population (1). It is characterized by non-scarring hair loss that preserves the hair follicle but without any hair shaft growth. It can be seen as patchy or diffuse hair loss. Alopecia areata affects the bulb of the hair follicle, causing the immune system to fight against its growth (anagen). Genetics is the most common cause for alopecia areata. This condition causes patchy bald lesions that may eventually lead to a complete loss of hair on the scalp.
What Happens When You Have Alopecia Areata?
The regular hair growth cycle happens in four phases – anagen, catagen, telogen, and neogen/exogen. In the anagen phase, the hair shafts grow from the hair follicles. Catagen is a regression period, while telogen is the resting phase. Exogen/neogen is the phase where the older hair shafts fall of and newer hair shafts grow from the follicle. Losing up to 100 strands a day is normal. Anything beyond this could mean a case of severe hair loss.
Alopecia areata is characterized by a rapid progression of follicles from the anagen phase to the catagen and telogen phases. This causes the hair shafts to fall out and leaves the affected follicles in a state of prolonged anagen (2). The development of new hair in the affected hair follicles is halted.
- Alopecia areata is the most common type of alopecia.
- It is a type of non-scarring hair loss.
- Alopecia is more common in men. In women, this condition seems to be more frequent in those over 45 years of age.
- The name “alopecia areata” was coined by Sauvages. The first clinical description of alopecia areata dates back to 14-37 BC (3).
- Alopecia areata accounts for 2% of the dermatology cases in the USA and the UK, 3.8% cases in China, and 0.7% cases in India (4).
Alopecia areata can occur in different types, which we will explore in the upcoming section.
What Are The Types Of Alopecia Areata
- Patchy Alopecia Areata: One or multiple distinct or joined patches of hair loss.
- Alopecia Totalis: Total loss of hair on the scalp.
- Alopecia Universalis: Total loss of hair on the body.
- Alopecia Incognita: Total loss of hair in a diffuse manner. It is diagnosed with a pull test, yellow dots, short and miniature hair regrowth, and a lack of nail development.
- Ophiasis: Hair loss occurring in a band-like shape along the circumference of the head, specifically near the ears and back of the head.
- Sisaipho: Chronic alopecia that occurs everywhere except the border of the scalp.
- Marie Antoinette Syndrome: A sudden “overnight” graying of hair paired with an episode of acute diffuse alopecia. This type of hair loss is more common with pigmented hair.
- Reticular Alopecia Areata: Patches of alopecia occurring with well-preserved narrow bands of hair in between (3).
- Diffuse Alopecia Areata: Widespread and acute hair loss, which is commonly mistaken for androgenic alopecia or chronic telogen effluvium (3).
Alopecia areata has multiple causes. We have covered them in detail in the following section.
Causes Of Alopecia Areata
- Genetic Factors: The most prevalent cause of alopecia areata appears to be genes. Alopecia affects twins, siblings, and generations of families with affected individuals. Single genes that are commonly associated with related autoimmune disorders have shown to play a role in alopecia areata.
- Autoimmune Disorders: Autoimmune disorders like vitiligo, lupus, and thyroid issues have been found to cause alopecia areata. Research shows that alopecia is four times more likely to develop in individuals with vitiligo (3).
- Auto-antibodies: Auto-antibodies have been noticed quite frequently in those dealing with alopecia areata. These antibodies induce anti-follicular activity and may even cause follicular inflammation (3).
- Cellular Immunity: Certain lymphocytes (a type of immune cells) may release cytokines that prevent follicular growth and inhibit hair synthesis (3).
- Atopy: Atopic diseases are commonly associated with early-onset and chronic forms of hair loss. Atopic diseases like sinusitis, asthma, rhinitis, and atopic dermatitis are common in people with alopecia areata (1). In Korea, patients with atopic diseases also had an early onset of alopecia areata.
- Trauma And Stress: Psychological trauma and emotional stress can cause alopecia areata. Stress and trauma produce neuromediators that may inhibit hair growth (3).
- Nutrient Deficiency: In a study, 24-71% of women with alopecia areata were found to have iron deficiency (5). Low zinc levels were also observed in patients with alopecia areata (6).
In the following section, we discuss the signs and symptoms of alopecia areata.
Here are some of the signs and symptoms of alopecia areata.
- Exclamation point hairs seen at the margins.
- Oval or round bald patches that appear on the scalp.
- The bald patches become smooth.
- Hair loss on different parts of the body.
- Appearance of new and larger bald spots that may join prior bald regions.
- Production of oil in areas with affected hair follicles.
If you experience one or more of these symptoms, consult a doctor for a professional diagnosis.
A case of alopecia areata can be confirmed by a biopsy and a trichogram.
- Biopsy: A biopsy determines the exact type of hair loss that occurs. A good sample of pillar follicles is extracted with a bistoury.
- Trichogram: Some hair is extracted from the border of a bald patch. This hair is checked to determine its growth phase.
Doctors might also perform a pull test (where hair is gently tugged to check if any hair is shed).
Natural Treatments: Alopecia areata has many natural forms of treatment. These treatments are said to have fewer to no side effects (7).
- Ginkgo biloba or Indian gooseberry mixed with coconut oil can be used to stimulate hair growth.
- Onion juice can be applied to hair by itself or paired with honey to stimulate hair growth and combat dandruff.
- Rosemary and lavender oils can be mixed with a carrier oil and massaged into the scalp to stimulate hair follicles.
- Walnut oil can be applied to hair roots and massaged into the scalp to promote hair growth.
- A paste of licorice, milk, and a pinch of saffron can be applied to hair and left overnight. This is an effective treatment for hair loss that may stimulate hair growth.
- Using hair packs and masks made of natural ingredients may improve hair health.
Medications like topical minoxidil, topical tretinoin, rubefacient, corticosteroids, intralesional infiltrations, anthralin, diphencyprone and cyclosporin might be prescribed to combat alopecia areata. However, these drugs can have side effects like hyperpigmentation. Immunotherapy and Puva therapy might also be recommended.
Aromatherapy may be an effective treatment for alopecia. The oils extracted from rosemary, thyme, lavender, wolf’s bane, basil and others may stimulate hair growth.
Minerals and vitamins play an important role in hair growth (8). A deficiency of minerals and vitamins can induce hair loss. Minerals like calcium, iron, copper, magnesium, iodine, and zinc support hair growth. Vitamins B3, B5, and folic acid, and vitamins A, C and E may improve hair health.
Note: Take nutrient supplements in prescribed doses. Excess supplementation may cause hair damage.
Overconsumption of vitamins and minerals can also cause hair loss. Many supplements often surpass the recommended dosage and may cause potential damage. The best way to ingest these nutrients is through your food. Eggs, yogurt, soy, green vegetables, nuts, carrots, fruits, etc. are all excellent sources of minerals and vitamins that aid body and hair health.
Apart from these treatment options, you also may follow certain tips to help prevent or slow down hair loss.
- Reduce the use of products with excessive chemicals as they can damage your hair.
- Regular exercise and yoga can help relieve stress and may help prevent associated alopecia areata.
- A healthy diet impacts your hair growth. Eat right and reduce the intake of processed foods.
- Opt for natural and organic hair care products, packs, and masks. Many natural ingredients are known to help stimulate hair growth and prevent hair loss.
- Massaging the scalp can stimulate hair growth by improving blood circulation (9). Massage your scalp with some warm oil once a week to promote hair growth.
Can Alopecia Areata Be Reversed?
Alopecia areata pushes hair follicles into a prolonged anagen phase and halts the hair follicle development. While the hair follicles are not damaged, they need to be restimulated to promote hair growth. Regular hair maintenance and the right treatments may help reduce alopecia areata, and hair may regrow in certain areas. However, more research is warranted in this regard. If hair regrowth is not stimulated, one may opt for hair transplantation and restoration therapies.
While hair loss can be worrying, remember that there are many treatment options available. There have been significant advances in these treatment options in the recent times (12). Along with the right diet, maintenance, and ideal lifestyle habits, you sure can enjoy better hair health.
Frequently Asked Questions
Can women also experience alopecia areata?
In rare cases, women may experience female pattern baldness. More research is warranted about this condition. Consult a doctor for further details.
How long does alopecia areata take to spread?
Alopecia areata can take anywhere between a few weeks or months and a couple of years to spread. Lack of timely treatment may lead to total hair loss.
Is castor oil helpful to treat baldness?
Castor oil is not often used in the treatment for baldness. There is anecdotal evidence that suggests castor oil might reduce hair loss. However, research is limited in this regard.
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- Alopecia Areata
- Alopecia Areata: Alter ations in the Hair Growth Cycle and Correlation With the Follicular Pathology
- Alopecia Areata: a Revision and Update
- Etiopathogenesis of Alopecia Areata
- The Diagnosis and Treatment of Iron Deficiency and Its Potential Relationship to Hair Loss
- Zinc and Its Status in Some Dermatologic Diseases–A Statistical Assessment
- Alopecia: Herbal Remedies
- The Role of Vitamins and Minerals in Hair Loss: a Review
- Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue