Alopecia and hair loss

Alopecia areata (AA) is a condition affecting humans, in which hair is lost from areas of the body, usually from the scalp.^[1] Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In 1%–2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis). Conditions resembling AA, and having a similar cause, occur also in other species.

The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.^[1]

• Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.^[1]
• Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
• Alopecia areata multilocularis refers to multiple areas of hair loss.
• The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.^[1]
• If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
• If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.^[5]

Alopecia areata totalis and universalis are rare.^[5]

Causes

Alopecia areata is not contagious.^[1] It occurs more frequently in people who have affected family members, suggesting that heredity may be a factor.^[1] In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.^[5]

The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth.^[1] There is evidence that T cell lymphocytes cluster around these follicles, causing inflammation and subsequent hair loss. An unknown environmental trigger such as emotional stress or a pathogen is thought to combine with hereditary factors to cause the condition.^[4] There are a few recorded cases of babies being born with congenital alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system. Alopecia can be an adverse effect from using Prilosec, which is a Proton Pump Inhibitor that is used in treating GERD, among other things.

As with most autoimmune diseases, alopecia areata is associated with increased risk of developing other autoimmune diseases, specifically systemic lupus erythematosus or SLE.

Diagnosis

First symptoms are small, soft, bald patches which can take just about any shape but are most usually round. It most often affects the scalp and beard but may occur on any hair-bearing part of the body.^[4] There may be different skin areas with hair loss and regrowth in the same body at the same time. It may also go into remission for a time, or permanently.

The area of hair loss may tingle or be very slightly painful.^[6]

The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.^[1]

Another presentation of the condition are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance.^[1]

One diagnostic technique applied by medical professionals is to gently tug at a handful of hair along the edge of a patch with less strength than would be required to pull out healthy hair. In healthy hair, no hair should fall out or ripped hair should be distributed evenly across the tugged portion of the scalp. In cases of alopecia, hair will tend to pull out easier along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy. Professionals usually remind patients that the hair that is pulled out would eventually fall naturally. The test is conducted only once to identify the condition and rule out a simple localized hair loss condition.

Nails may have pitting or trachyonychi.

Treatment

Since the exact mechanisms are not ultimately understood, there is no known cure to date.

About 50% of patients' hair will regrow in one year without any treatment.^[1] If the affected region is small, it is reasonable to observe the progression of the illness as the problem often spontaneously regresses and the hair grows back. In 90% of cases, the hair will, ultimately, grow back. In the other 10%, only some or no hair will regrow.

In cases where there is severe hair loss, there has been limited success treating alopecia areata with clobetasol or fluocinonide, steroid injections, or cream. Steroid injections are commonly used in sites where there are small areas of hair loss on the head or especially where eyebrow hair has been lost. Some other medications used are minoxidil, irritants (anthralin or topical coal tar), and topical immunotherapy cyclosporine, each of which are sometimes used in different combinations.

Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs have adverse side effects.^[4]

Initial stages may be kept from increasing by applying topical corticosteroids. However, topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.^[4]

Hair implants may help covering bald spots, but cannot guarantee satisfactory outcome, since the bald areas might expand.

Wigs can be prescribed if patients, especially female patients, mention social discomfort.

Avoiding Hair Care Disasters: Use Caution With Hair Relaxers

Hair relaxers and hair dyes are among the top consumer complaint areas. Complaints range from hair breakage to symptoms warranting an emergency room visit. Reporting such complaints is voluntary, and the reported problem is often due to incorrect use of a product rather than the product itself. FDA encourages consumers to understand the risks that come with using hair chemicals, and to take a proactive approach in ensuring their proper use.

Complaints about scalp irritation and hair breakage are related to both lye and "no lye" relaxers. Some consumers falsely assume that compared to lye relaxers, "no lye" relaxers take all the worry out of straightening.

But both types of relaxers contain ingredients that work by breaking chemical bonds of the hair, and both can burn the scalp if used incorrectly. Lye relaxers contain sodium hydroxide as the active ingredient. With "no lye" relaxers, calcium hydroxide and guanidine carbonate are mixed to produce guanidine hydroxide.

Research has shown that this combination in "no lye" relaxers results in less scalp irritation than lye relaxers, but the same safety rules apply for both. They should be used properly, left on no longer than the prescribed time, carefully washed out with neutralizing shampoo, and followed up with regular conditioning. For those who opt to straighten their own hair, it's wise to enlist help simply because not being able to see and reach the top and back of the head makes proper application of the chemical and thorough rinsing more of a challenge.

Some stylists recommend applying a layer of petroleum jelly on the scalp before applying a relaxer because it creates a protective barrier between the chemical and the skin. Scratching, brushing, and combing can make the scalp more susceptible to chemical damage and should be avoided right before using a relaxer. Parents should be especially cautious when applying chemicals to children's hair and should keep relaxers out of children's reach. There have been reports of small children ingesting straightening chemicals and suffering injuries that include burns to the face, tongue, and esophagus.

How often to relax hair is a personal decision. Relaxing at intervals of six to eight weeks is common, and the frequency depends on the rate of a person's hair growth.

Consumers should be aware that applying more than one type of chemical treatment, such as coloring hair one week and then relaxing it the next, can increase the risk of hair damage.

Hair Loss and Heart Disease

Baldness may be more than just a cosmetic indignity: it could be a marker of heart disease risk, especially in men with other risk factors such as high blood pressure or high cholesterol.

Heart attacks, chest pain due to blocked arteries (called angina), and the need for balloon angioplasty or bypass surgery all are forms of heart disease, the researchers explained.

High blood pressure was associated with an 80% increase in heart disease risk if the men were also bald. Mild and moderate vertex baldness were also associated with an increased risk of heart disease, but to a lesser extent. Frontal baldness -- a receding hairline -- had little relationship to heart disease. The researchers saw that the men with more severe hair loss developed more heart disease during the 11 years they were watched than men with only mild to moderate hair loss, suggesting a link between the degree of hair loss and heart disease risk.

The biological link between hair loss and heart disease could involve elevated levels of male hormones, says Manson, an endocrinologist and chief of preventive medicine at Harvard Medical School and Brigham and Women's Hospital in Boston. The scalp has a higher density of male-hormone receptors, and high levels of hormones such as testosterone are associated with an increased risk of hardening of the arteries and blood clotting. Although this study did not include women, Manson says that true male-pattern baldness in women, which is associated with an increase in male hormones, has been linked to an increased risk of high blood pressure, diabetes, and abnormal cholesterol, all of which raise the risk of heart disease. She cautions, however, that this finding has not been well studied.

Men certainly can't change their pattern of hair loss, Manson says, "and we don't yet know if the medications used to prevent hair loss in men will decrease [heart disease] risk." However, "male-pattern baldness may be a useful marker of men who could benefit from vigilant modification of risk factors we can change. This finding could be a message for increased attention to screening and preventive measures to lower the risk of heart disease in this population."

Information about Hair Loss

Hair loss and baldness are more treatable than ever. Familiarize yourself with today’s treatment options for alopecia, male pattern baldness, and thinning hair in both men and women.

Baldness involves the state of lacking hair where it often grows, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or 'male pattern baldness' that occurs in adult male humans and other species. The amount and patterns of baldness can vary greatly; it ranges from male and female pattern alopecia (androgenic alopecia, also called androgenetic alopecia or alopecia androgenetica), alopecia areata, which involves the loss of some of the hair from the head, and alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body.

More than half of men are affected by male pattern baldness by age 50, and baldness treatments are estimated to be a US $1 billion per year industry.^[1] Since the 1980s, drug therapy has increasingly become a realistic management option for baldness for men and women. Increased understanding of the role of dihydrotestosterone (DHT) in male and female pattern baldness has led to targeted intervention to prevent this hormone from acting on receptors in the scalp. Coupled with chance discoveries and the ever-present lure of a breakthrough involving stem cells and hair multiplication, scientifically proven baldness treatments continue to be an area of research that receives a large amount of funding.