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Alopecia Areata--Hair Loss Part 2 (Hair Care)
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Alopecia Areata--Hair Loss Part 2

John Kraft and Charles Lynde, MD, FRCPC

In the second of a two part series on hair loss, we will cover alopecia areata, a form of non-scarring hair loss. In this condition, the hair follicles are present and visible, but the hair is often thinned or lost. Alopecia is considered to be an autoimmune disease. In alopecia areata, the immune cells attack the bulb region of the hair follicle, an area that is usually outside of the range of immune defences. This causes the hair to fall out while leaving the hair follicle itself intact. Since there is no permanent damage to the hair follicle, hair may regrow over time. Alopecia areata is a relatively common condition in North Americans, affecting approximately 1 or 2 persons in a 1000.

90 to 95% of hair in the scalp is still growing, or in the anagen phase, while the rest of the hair is preparing to shed, called the telogen phase. In alopecia areata, the telogen hair is lost on the scalp, eyebrows, eyelashes, and beard, but can also affect other body hair. Typical signs include oval patches of lost hair. There are a variety of patterns of hair loss, including localized loss of scalp hair, or universal hair loss.

Below are some other possible causes of non-scarring hair loss:

  • Childbirth
  • Hormonal problems such as hypothyroidism or androgen imbalance
  • Toxins such as anticoagulants, chemotherapy, heavy metals, vitamin A
  • Iron or Zinc deficiency
  • Physical damage to the hair follicle through corn-row braiding or trichotillomania
  • Other severe illness

Treatment of alopecia areata can be difficult due to its unpredictability. Hair may grow after months in some cases, with 50% of people showing regrowth after a year, but some patients will not grow hair for many years. Stress is strongly linked to recurrence of the condition. In all cases, treatment is designed to suppress the immune response that is causing the hair loss.

Topical or intralesional corticosteroids, anthralin, and topical minoxidil can be used to treat localized patches of alopecia areata. Corticosteroid injections are usually given every 4 to 6 weeks. This treatment comes with the risk of thinning skin, but this side-effect often resolves over time. With this treatment, most patients will see hair growth after 6 months. Treating extensive alopecia areata will often involve the use of topical immunotherapies, psoralen and ultraviolet A light (PUVA).

A scalp biopsy can also help in finding an optimal treatment. The areas with little inflammation can be controlled with 5% topical minoxidil, while corticosteroid use may be necessary to treat areas with significant inflammation. In addition to treatment, the use of wigs may also help for severe cases of alopecia areata. There are many support groups in local communities and on the internet for this condition.

Finally, alopecia areata are often associated with other conditions such as nail changes. Pitting, ridging, dystrophy, brittleness, and onycholysis (the removal or the nail from the nail bed) are found in 10 to 20% of alopecia areata patients. Other immunological diseases such as Atopy, thyroid diseases, vitiligo, Addison’s disease, persistent anemia, and inflammatory bowel disease are also often associated with alopecia areata.


alopecia,   hair care,   hair loss,