Information About Alopecia Areata
Alopecia Areata Frequently Asked Questions:
The following are frequently asked questions on alopecia areata. The information provided is not meant to be a substitute for the information obtained at an evaluation and by discussion with a physician, but merely to encourage understanding of this condition. No questions regarding individual scenarios will be answered by the AHRS. No changes in treatment should be undertaken by a patient without discussion first with the patient's physician.
I have no family history of hair loss. Alopecia areata is considered to be an autoimmune disease. In alopecia areata, this means that immune system cells called white blood cells attack hair follicles. Hair fibers are shed and the hair follicle/hair fiber growth process is slowed down. Genetic factors may be important in disease susceptibility and severity but overall, scientists do not know exactly why the immune system attacks hair follicles in some people. In those who are genetically predisposed, it is possible some type of trigger, such as something in the person's environment or a virus, triggers the attack on the hair follicle.
Alopecia areata may occur more commonly in people who have other autoimmune diseases such as thyroiditis, Addison's disease, and pernicious anemia (Vitamin B-12 deficiency). Therefore, it is important your doctor take a careful medical history and obtain any necessary blood tests based on your medical history and physical examination.
There is no "cure" for alopecia areata and in the United States there are no specific drugs which are approved specifically for the treatment of this disease. There are however, medications which are commonly prescribed to promote hair growth or to reduce the inflammatory (autoimmune) reaction around hair follicles. Your dermatologist will be familiar with these medications and how to use them in the management of alopecia areata.
This is a difficult question to answer as the course of the disease varies from person to person. Your child may regrow his hair spontaneously and never have another episode of hair loss again or he may regrow his hair only to lose it again later with a recurrent episode of alopecia areata. Some people with alopecia areata may never grow back their lost hair. Medical treatment of his alopecia totalis may help him regrow his hair but again one cannot guarantee the alopecia areata will not recur. From published research studies, it appears the outlook or prognosis for hair regrowth will be positive if the disease has been present for less than two years and your child does not have atopy. Atopy is the term used to describe three major diseases including asthma, allergic rhinitis (hay fever) and atopic dermatitis (eczema). Some, but not all, researchers have reported a worse prognosis if severe nail changes are also present. The nail changes which have been described include thinning of the nail plate and severe pitting and ridging.
Topical sensitizers are medications which when applied topically create an allergic reaction which is characterized by itching and redness. If this therapy works, new hair growth is usually seen in 3 to 12 months. There are three topical sensitizers which are used in medical practice. Their names are dinitrochlorobenzene, squaric acid dibutyl ester and diphenylcyclopropenone. These chemicals are available in the United States but their use in the management of alopecia areata has not been subjected to vigorous testing as required by the Food and Drug Administration. It is anticipated that in the very near future the type of testing required by our government will be initiated in volunteer patients with extensive hair loss.
M.D. Anderson Cancer Center, Houston, Texas
Principal Investigator: Madeleine Duvic, M.D.