When a person gets alopecia areata, patchy bald spots appear on sections of the scalp. Sometimes, the entire scalp and body is denuded of hair, including eyelashes, nasal hair and eyebrows. This is because the body’s immune system has gone haywire, ordering white blood cells – which normally help repel invasive viruses and bacteria – to attack the hair follicles from which hair sprouts.
The result is that the follicles become smaller and slow down their production of hair. Because people lose about 75 to 150 strands per day on average, this results in bald spots appearing or large clumps of hair falling out.
The good news that the stem cells that supply the hair follicle with new cells do not seem to be affected, which means there is hope of re-growing hair by stimulating the shaft to induce new growth.
Who Gets Alopecia?
About 2 percent of Americans in equal numbers of men and women get alopecia areata. There are no ethnic boundaries of the disease, but people younger than age 20 seem to be the biggest targets. People with a family history of alopecia areata are more likely to get it. People who suffer from another autoimmune disease, like Crohn’s disease, or those with allergies, may be more prone. One other tell-tale sign of the disease’s onset is that the fingernails and toes may develop an unusual shape, color or thickness and may also develop pitting or denting.
Fortunately, alopecia areata is not a life-threatening or physically painful disease. But because it affects the appearance, particularly among young people at a sensitive stage of social development, there can be psychological fallout as well as hair fallout. There is some concern if the nasal hair, eyebrows and eyelashes also fall out, because dust, dirt and other debris have a clearer path to affecting those organs. But wearing sunglasses and using moisturizing sprays to keep the nasal passages lubricated will help deflect those issues.
Parents are often concerned that they may pass on the disease to offspring. Alopecia areata is tricky to predict, unlike some other problems. Because there are a set of genes necessary to develop alopecia, not everyone has all of them, and in fact, it is believed to be highly unlikely that a child would get all of them. Studies on twins have also found that even though one twin may have alopecia areata, there is only a 55 percent chance that the other twin will be afflicted.
This has led some researchers to believe that beyond genetics, there may be environmental or psychological triggers in the onset of alopecia areata. Although stress can make hair fall out, there is no definitive research yet to suggest that it may trigger alopecia. It may be that alopecia areata works in conjunction with other body organs, like the thyroid, to induce the condition. There also may be an issue with exposure to chemicals, lack of certain vitamins or the possibility that alopecia areata is a side effect of some other disease like arthritis, an as-yet-undiscovered virus may induce the condition. For now, all there is speculation tied to genetics, but research continues.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has an alopecia areata registry that collects information on the condition and provides information on the latest research available. The organization and others also offer support groups and counseling to those afflicted with the disease.
Hair Today, Back Tomorrow? Alopecia Treatments
Beyond the causes of the disease, the biggest question for those afflicted with alopecia areata is whether they will ever get their hair back.
For most, the answer is a qualified yes. Some cases of alopecia areata are temporary, and the hair does grow back. But in some cases, it returns thinner and lighter in color. There are treatments that can help regrow hair by using topical, oral and injectable steroids and drugs. There are also some surgical options where the scalp area can be reduced to tie in sections where hair still grows to cover the bald spots. But in about 5 to 10 percent of cases, the hair does not grow back.
The National Institutes of Health are studying various ways to attack the alopecia areata problem. Methods currently underway include:
1) Animal testing – Mice with similar issues to human development of alopecia areata are being studied to determine how the disease might progress in humans. Once the triggering mechanism is determined, potential ways to fix the issue can be developed.
2) Hair follicle studies – There is still much that is unknown about how hair develops, forms and grows. Because stem cells are not affected by alopecia areata and still can send signals to help hair follicles, it’s hoped that connection will reveal the root causes of alopecia areata.
3) Gene therapy – Scientists have identified the genetic variations that cause alopecia areata. They have also determined the disease is similar to the onset of type 1 diabetes, celiac disease and rheumatoid arthritis, among other autoimmune issues. As research into gene therapies develops, it is hoped that a way to stop whatever signal the genes use to trigger alopecia and other autoimmune diseases can be developed.
Until a breakthrough is made, alopecia areata sufferers will have to contend with treatments that can offer relief, but not a cure. Parents, coaches, teachers, business associates and others who know of someone who has the condition should know that it is not contagious, and the afflicted person is otherwise healthy. The biggest concern with alopecia areata is psychological, so treating the afflicted normally and with dignity is perhaps the best way to provide support.