Alopecia areata: the best treatment

Have you ever seen someone with small, coin-shaped bald patches on their scalp? Do you know what this condition is called? What causes these patches to form? How is it treated? In this post, we explain what alopecia areata is and what the best treatment is.

This condition is known as ALOPECIA AREATA. It affects approximately 2% of the general population and can occur in both men and women. It usually presents as well-defined patches of hair loss ranging from small (1 cm) to very large. They may even affect the entire scalp, progressing to alopecia totalis. This type of alopecia can also appear as small bald patches in the beard in men.

In dermatology, this type of alopecia is classified as a non-scarring alopecia. These are forms of alopecia that do not leave scars and can be reversible. In alopecia areata, the hair cycle and/or the size of the hair follicle are altered. The follicle does not disappear but remains in the telogen phase (without hair).

The exact cause of alopecia areata is not well defined, but we do know that it is an autoimmune disease. In other words, our immune system acts against the hair follicles, causing well-defined areas of hair loss. In fact, skin biopsies of areas affected by alopecia areata have shown lymphocytic infiltrates (inflammatory cells) within and around the hair bulb or in the lower part of the hair follicle during the anagen phase (growth phase).

Stress can be a trigger for the development of alopecia areata. Periods of intense workload or even an unexpected event in our lives may cause these small bald patches to appear on the scalp or beard.

It has recently been discovered that genes (GWAS genome) are involved in the development of alopecia areata. However, additional factors are required for the disease to be triggered. It is a complex, polygenic, immune-mediated disease in which biomarkers can be identified to differentiate its severity.

Its diagnosis is primarily clinical and can be supported by digital trichoscopy and a skin biopsy.

In alopecia areata, it is possible for the hair to grow back. However, this process may take many years and, in some cases, the hair may never regrow. This is because the disease process does not destroy the hair follicles.

Alopecia Areata: Treatment

Not all patients need or wish to receive active treatment for alopecia areata. Remission may occur spontaneously in patients with a short disease duration (<1 year). When remission occurs, whether due to treatment or spontaneously, it usually begins around 3 months after the bald patch first appears.

Long-standing alopecia areata has a less favourable prognosis and, at present, all available treatments have a high failure rate. This is why it should be assessed and treated by specialists who can determine whether a solution is possible.

Treatments range from the use of corticosteroids (topical, oral or injected) to immunosuppressive drugs such as methotrexate or tacrolimus, although these have been shown to be ineffective in clinical trials.

The newest treatment approaches include biologic therapies such as monoclonal antibodies, including secukinumab, which is a human IL-17A antagonist currently indicated for the treatment of adult patients with plaque psoriasis, active psoriatic arthritis and active ankylosing spondylitis. JAK 1-2 inhibitors such as ruxolitinib and tofacitinib are also being studied, with promising results.

As we can see, research is ongoing to better understand the causes of alopecia areata and to develop more effective treatments for this type of alopecia, which affects a significant proportion of the population.

At Instituto Médico del Prado, we always recommend placing yourself in the hands of an expert in Hair Medicine or a trichologist to treat any type of scalp disorder.

Bibliography

Alopecia Areata. Current situation and perspectives

Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis

Emerging drugs for alopecia areata: JAK inhibitors

Management of alopecia areata: Updates and algorithmic approach

Dr. Espinosa Custodio works at Instituto Médico del Prado, his hair clinic in Madrid, and performs hair transplants in Mexico, twice a year. If you would like to make an appointment, you can contact us on +34 912 468 664, on WhatsApp +34 627 396 322 or on the contact page of our website. From Mexico you can contact us at +52 55 4590 9909.