Alopecia Areata

 Hair-Spot Baldness

Definition:

Alopecia Areata is called Spot Baldness. Its a condition in which Hair lost from one area of the scalp mostly or multiple areas of the scalp or from some hair bearing part of the body also.

                                                            Fig-Alopecia Areata

In 1-2% case it can spread to the entire scalp or entire body.It is most common in children and adults. Its completely a unpredictable in nature so you can not predict when it gets worse or when it gets better its completely depends on individual body response and that's we call Immune System of the individual.

Its also a Non-Scaly condition & that means there is no scaling from bald spot. Till now no exact cause is identified for this unique baldness.

It affects males & females equally.It is common in children. It may be scaring or non-scaring in nature.

Classification:

Classification of Alopecia Areata is done depending upon the pattern,area & distribution of hair loss.

1-Diffuse Alopecia Areata: Hair loss whole over the scalp diffusely & that's why named itself suggests.

                                           

                                                     Fig-Diffuse Alopecia Areata

2-Alopecia Areata Monolocularis: Baldness only in one spot and it may occur anywhere on the scalp.

                                                       Fig-Alopeica Areata Monolocularis. 

3-Alopecia Areata Multilocularis: Baldness occurs in multiple spots on the scalp not only in single one.

                                                     Fig-Alopecia Areata Multilocularis

4-Ophiasis:  Hair loss in shape of wave in nape of the neck.

                    

                                                                     Fig-Ophiasis

5-Alopecia Areata Barbae: This can also appear in beard & its called Alopecia Areata Barbae.

                                                     Fig-Alopecia Areata Barbae.

6-Alopecia Totalis: When hair loss all over the scalp only not in single or multiple spot but covers all the scalp , its called Alopecia Totalis. Its a rare case.

                                                    Fig-Alopecia Totalis

7-Alopecia Universalis: When  hair lost in mostly every hair bearing part of body like eyebrows,beard,pubic area, its called Alopecia Universalis. And its also very rare condition .

                                                         Fig-Alopecia Universalis 

Clinical Features:   Clinical features including sign & Symptoms.

Symptoms: Actually it does not have major symptoms that patient feels to explain but a few symptoms are present like Tingling sensation in the spot or a mild pain in the spot or sometime it may it.

Mild to moderate burning and tenderness also present.There is crawling sensation or pain but this symptom is before the appearance of the patch.

Sings: Signs are major one to make it clear presentation. Following are major signs of Alopecia Areata.

1-Shape-Oval or round in shape

2-Bald small patch

3-Patch is pinkish red in colour .

4-Hairs are seen like intact or broken.

Followings are the sign of Active Alopecia Areata and by this we can understand that Spot Baldness can spread or not.

1-Hair Pull Test-In this test we just pull the hairs from periphery of the area & if hair comes out in hand, it means that its active in stage and can spread further. But how long can it spread , its cult very difficult to say.

Diagnostic Mark:  Following are the diagnostic mark for confirmation of Alopecia Areata.

1-Yellow Dots: There is regular distribution of Hyperketotic plugs & yellow in colour seen under the Trichoscopy.

                                                          Fig-Yellow Dots.

2-Black Dots: This is also called Exclamation Point in which there is deposition of destroyed hairs in opening of hair follicles.

                                

                                                          Fig-Black Dots

3-Swarm of Bees: This is rarely needed because it is found under Biopsy.There is deposition of peribubar lymphocytes. As it looks like Bees swarm so its called Swarm of Bees like we called in hindi "Madhumakkhi ki Jhund".

                                                 Fig-Swarm of Bees

Etiologic Factors: First of all its not a contagious one but still large group of people thinks its contagious in nature & basically it is believed in India.

Till now so many research has been done to find out the cause of this kind of baldness but as I earlier said the exact cause it not know about this Spot Baldness. But most of people found one common cause that we called Immune induced Disease in better way Auto-Immune Disease. Causes are described as per my knowledge but there are also so many causes can be considered.

So, basically here 2 major factors are causal factors for this.

A-Genetic Factor

B-Immunological Factor

A-Genetic Factor: First we will discuss the Genetic Factor and in regard to this let me tell you there somewhat genetic relation also.

-10-42% cases are related to genetics .

-37% cases are found in 30 years of  age group.

-7.1% cases after 30 years of age group.

-8.8% cases in Down Syndrome also(Down syndrome is a genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21)

B-Immunological Factors: There are clues for the immunological factors.

1-Indirect Clues for Auto-Immunity

2-Direct Clues for Auto-Immunity.

1-Indirect Clues for Auto-Immunity-In this we will talk about the Thyroid & Vitiligo. You may astonished to know that 8-11% Thyroid patients can have the Alopecia Areata if not controlled in proper way.Same like this Vitiligo patient can also have this.

Alopecia Areata associated with Diabetes Mellitus,Pernicious Anaemia,Lichen Planus et.

2-Direct Clues for Auto-Immunity- its completely a cell mediated immunity by T.Lymphocytes

Here a detail explanation is needed but not needed for simple understanding for this so just by looking at figure you can understand.

Prognosis: In most of the cases when number of patch is one that is in the case of Alopecia Areata Monolocularis hair grows back within few months to a year.

In case of Alopecia Areata Multilocularis hair either grows back or can progress to Alopecia Totalis or Universalis rarely.

It affects the patient at emotional & psychological level, it damages the self confidence of the patient.

At certain level individual faces the anxiety & depression also.

Treatments:The rate of accuracy of any kind of treatment in case of Alopecia Areata is very very difficult because hair regrowth often seen in the spot and due to unstructured nature of this baldness it may show relapses,increase in size even on regular treatments.

History-There the is a small history regarding the treatment of AA. There was a person named Bateman in the 1800s, who wrote about the AA & its treatment.He simply advised to apply caustic substance & he saw the success also.

And still this crude mode of treatment is going on even after 200 years of development of medicine.

And till now FDA does not approve any medicine but if does not mean that there is no any effective treatment for AA.

As of now all mode of treatments are controlling one or palliative one just make it not to spread further but not curing one.And any mode of treatment needs a long period of duration for treating the disease.So, followings are the treatments available in modern school of medicine.

1-Topical

2-Intralesional

3-Systemic Steroid

4-Topical Immunotherapy

5-Anthralin

6-Minoxidil

7-Photo-chemotherapy

1-Topical: The main action of Topical corticosteriod is immunosuppression. Combination of betamethasone dipropionate cream & minoxidil may be helpful.

2-Intralesional : Intralessional corticosteroid injection also used for treating the AA in case of less than 50% scalp involvement but not in more than 50%. A lesser concentration can be used for Beard & eyebrows.

3-Systemic Steroid: Systemic steroid  is seen effective in line of Tx but its not used frequently because of its side-effects and also not showing the long term prognosis.

4-Topical Immunotherapy: Topical immunotherapy is the most effective line of treatment of AA with major safety major in compare to systemic steroid. Three contact sansitizers used for treating the AA.

-Dinitrochlorobenzene(DNCB)

-Squaric acid dibutyle ester(SADBE)

-Diphenylecyclopropenone(DPCP)

  

5-Anthralin: Anthralin is acting as a immunomodulating agent as it does in Psoriasis also. In case of 20-25% cases hair regrowth seen in AA cosmetically.But should not be used for eyebrows & beard area.This therapy is very effective & regrowth could be seen within 3 months and its good choice in case of children.

6-Minoxidil: Minoxidil is also a good choice for treating the AA. It acts by enhancing the blood circulation. 5% is generally used & success seen after 1 year of use.

7-Photo-chemotherapy: Photo-chemotherapy acting as a immunological agent by affecting T-cell function & antigen presentation and inhibit the immunological attack against hair follicle.

Natural Remedies: Natural remedies are very effective alternative mode of treatment for treating AA & has been used very widely.

Following are the natural remedies that have been used for treating AA.

1-Essential Oil

2-Onion Juice 

3-Hypnosis

So, this is all about the Alopecia Areata as per my best of best knowledge but anything more you want to know, you can give our question in comment.

                                            

                                               *HaveGoodHair & LiveGoodLive*