Have you ever seen someone with small coin shaped balding patches on their scalp? Do you know the name of this condition? Why do these patches appear? How are they treated? In this post we’ll tell you what is Alopecia Areata and which is the treatment.

This disease is known as ALOPECIA AREATA and it affects 2% of the general population, and it can be present in both males and females. It normally appears as hair loss in well delimitated patches that can go from small (1cm) to very large, and they can even take the whole head. This kind of alopecia can also be observed as small hairless patches in men’s beards.

In dermatology, this kind of alopecia is classified in the category of non-scarring alopecia. These kinds of alopecia don’t leave any scars and can be reversed. These alopecia areata can alter hair cycle and/or the follicle size, the follicle doesn’t disappear, but it remains in the telogen (hairless) phase.

Its causes are not well defined, but it is an autoimmune disease. In other words, our immune system acts against hair follicles making it fall in a delineated way. In fact, on skin biopsies, affected areas with front fibrosing alopecia were found with lymphocytic infiltration (swelling cells) in and around the bulb or in the lower part of the hair follicle in anagen phase (growing phase).

Recently, genes (GWAS genome) have been discovered to be implied in the development of alopecia areata, however, they need other factors for it to set off. It is a complex, polygenic and immune-mediated disease where we can identify biomarkers to discriminate its severity.

Its diagnosis is purely clinic, and it can be supported with digital trichoscopy and skin biopsy.

In alopecia areata, it is possible to have hair growing back. However, this process can last many years and it may even not grow back. This is due to the disease process which doesn’t destroy hair follicles.

What is its treatment?

Not all patients need or wish an active treatment. Remission can happen spontaneously in patients with short term (<1 year) alopecia areata. In case that this happens, if its either because of treatment or spontaneously, it usually happens 3 months after the bald patch appears.

Long lasting alopecia areata has a less favorable prognosis and, currently, every treatment has a high failure rate. That is why it must be treated and evaluated by experts, to help you know if your alopecia areata could have a solution.

Treatments go from using corticosteroids (topic, oral or infiltered), or using immune suppressors, such as motrotexate or tacrolimus, even though these have been proven ineffective in clinical trials.

New treatment lines are: biologic such as monoclonal antibodies, like Secukinumab, which is a IL17A human antagonist currently indicated for treating of adults with psoriasis patches, active psoriatic arthritis and active ankylosing spondylitis. JAK 1-2 ruxolitinib or tofacitinib inhibitors are also being studied with promising results.

As we can observe research is being carried out to get to know the causes better and to have more efficient for this type of alopecia that affects a great part of the population.

From Instituto Médico del Prado we always advise to get in hands of a capillary medicine expert or trichologist to deal with any kind of alteration of the scalp.

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.