Alopecia areata: Types, Causes, Symptoms, and Remedies

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Alopecia Areata, Guide | HairMD | June 1, 2021

The love we have for our hair is boundless. It makes up a big part of our appearance, and we put in a lot of effort to maintain it. Sometimes, however, despite following a proper hair-care regimen, you may find patches of baldness on your scalp or even bundles of hair on your bed. It may be a condition called Alopecia.

Let us take an in-depth look at what constitutes this condition and how to manage it.

What is Alopecia Areata?

More than 147 million people across the globe are affected by Alopecia. It is a common autoimmune condition that causes hair loss in several parts of the body. Autoimmune diseases are those caused by a mistaken immune response. It means that our immune system, which typically safeguards us against harmful external bodies, mistakenly attacks cells of our body, believing them to be foreign objects. That can potentially lead to several disorders, of which alopecia areata is one. 

An attack on healthy hair follicles causes them to reduce in size, and hair production comes to a standstill. In most cases, hair fall happens in small quantities that are not usually noticeable. As the condition progresses, balding patches become visible. This process happens in a phased manner, which is triggered when the anagen or growth phase is cut short and many hairs on the head go to the telogen or resting phase around the same time. This results in increased hair fall in the exogen or shedding phase. Such a disruption in the hair growth cycle often leaves one with bald patches.

Loss of hair, however, does not just happen on the scalp; it may occur on the eyelashes, eyebrows, face, and other parts of your body as well. Alopecia areata beards are common in men over 30. The condition may also progress slowly and can recur after long durations. 

Alopecia Areata: Quick facts

  • Every one in five people with alopecia areata has a relative who is suffering or has suffered from it.
  • It sometimes progresses rapidly over a couple of days or weeks.
  • The scientific evidence of stress being a causative factor for the condition is less.
  • Individuals with a mild version of the condition frequently recover fully without the need for treatment.
  • The ratio of males to females affected by the condition is 1.4:1
  • About 1 in 10 people with Alopecia lose all body and scalp hair. This condition is called Alopecia Universalis.
  • 1 in 5 people with the condition suffers from complete baldness.
  • It can be seen in all age groups, even children.
  • There is a chance of regrowing hair with alopecia totalis as follicles are not destroyed completely.
  • Almost 40% of males aged 30 or above experience the condition. 

Types of Alopecia Areata

Alopecia Totalis

This can be described as complete balding of the scalp.

Alopecia Universalis

Apart from balding and patches on the scalp, individuals suffering from this condition also have hair loss on the face, i.e., eyebrows and lashes. They may lose hair on other body parts as well.

Androgenic Alopecia

The hair loss in men occurs in an ‘M’ pattern, whereas women experience hair thinning near their hair partition. 

Causes of Alopecia Areata

The condition has no known cause. Your white blood cells attack healthy cells in your hair follicles, which causes the hair production rate to slow. Pinpointing the causative factor behind this process is difficult. Extensive research in the field has helped scientists identify a genetic nature to it, indicating that the condition’s occurrence is more likely if a blood relative suffers from Alopecia. About one in every five persons with the condition has a relative who suffers from the same.

A common belief is that stress is the cause of Alopecia, but there is little research to support this claim. While cases of high-stress could hasten the condition, scientific research points mostly to genetic factors. 

People with a family history of the condition have been found to have other autoimmune conditions like thyroiditis, atopy, vitiligo, etc.

Risk factors to alopecia areata

Numerous factors come into the picture when excessive hair loss occurs, such as genetic and environmental causes. You are more likely to suffer from the condition if you have:

  • A blood relative with the condition
  • Asthma
  • Frequent allergies
  • Down syndrome
  • Pernicious anaemia
  • Vitiligo
  • Diseases of the thyroid

Signs and symptoms of Alopecia Areata

Patchy hair loss is the most definitive sign of alopecia areata. Your scalp starts losing hair in a patchy pattern. Hair loss is not just limited to the scalp and can occur elsewhere, like your beard or eyelashes. The condition may progress quickly or slowly. Itching and occasional burning sensations may be experienced in the affected areas. As the condition doesn’t completely destroy hair follicles, there is hope for regrowth if the inflammation is dealt with. Individuals with low-grade hair loss typically recover completely without much treatment. The experience varies from person to person; some with the condition have a cycle of loss and regrowth. In others, the disorder progresses extensively. You may also have more than a single episode of the disorder. 

While almost half the people recover from it, around 10-15% can develop alopecia totalis or Universalis. The disorder also causes changes in your nails, which is commonly an indicator that Alopecia is developing. Here are a few of the noticed changes:

  • Dot-like dents on the nail
  • White spots and lines 
  • Roughness
  • Loss of shine
  • Thinning

Other signs to watch out for if you suspect you have alopecia areata are:

  • Short hairs that narrow towards the end and have their roots either in the balding patches or around it. These are called exclamation mark hairs.
  • Growth of white hair in the affected area.
  • Cadaver hairs can be described as those that break without reaching the surface of the skin.

Diagnosing Alopecia Areata

Knowledge of the early signs and symptoms of the condition can help you fix an early appointment with your dermatologist. During your first visit, your dermatologist will:

  • Assess the symptoms you are experiencing
  • Assess the extent of hair loss and check the affected areas
  • Check whether the hair in the affected areas gets pulled out without difficulty
  • Check hair quality to look for strands that are not normal in appearance
  • Check your nails to examine if they have been affected

Your doctor may take a few hair samples to examine them microscopically to understand the condition. In several cases, a biopsy is performed to eliminate the possibility of the hair loss being due to other causes, such as infections. It is a simple procedure during which the dermatologist removes a bit of your scalp skin to check for causative factors. A series of other tests could be ordered if they suspect autoimmune disorders. These will most likely include a test for abnormal antibodies. Your doctor may also order other tests to rule out causes, including:

  • C-reactive protein test
    Normal value: <10 mg/L
  • ESR (Erythrocyte Sedimentation Rate)
    Normal value: 0-22 mm/hr (for men) and 0-29 mm/hr (for women)
  • Haemoglobin
    Normal value: 13.5-17.5 g/dL (for men) and 12.0-15.5 g/dL (for women)
  • Thyroid testing
    Normal value: 0.4-4.0 mIU/L
  • Antinuclear-antibody test
    Interpreted in positive or negative
  • FSH and LH (Follicle Stimulating Hormone and Luteinizing Hormone)
    Normal value: 1.24–7.8 IU/L (for men); for women, 1.68–15 IU/L (in follicular phase), 21.9–56.6 IU/L (in mid-cycle peak), 0.61–16.3 IU/L (in luteal phase)
  • Testosterone tests
    Normal value: 300-1,000 ng/dL (for men), 15-70 ng/dL for women

Prognosis of Alopecia Areata

The way the condition progresses will be unique for each individual and not predictable. While some people have significant and consistent hair fall, others may go through the ordeal just once. That also holds true for recovery. Poor recovery can be due to several reasons, such as:

  • Too much hair loss
  • Having alopecia areata from a young age
  • Changes in your nails
  • Genetic factors
  • Presence of different autoimmune disorders

Treatment options for Alopecia Areata

While alopecia areata is not curable, it is manageable, and regrowth of hair is possible. Due to its unpredictability, there is a wide range of alopecia treatment options, and you can opt for one or more depending on the severity. The medical treatment options offered for this condition include:

Topical treatment

These are medicines that can be applied to your scalp to foster the growth of hair. Several medications are available, and they can be purchased over-the-counter or prescribed by your dermatologist. The most widely used topical agents for alopecia areata are:

Minoxidil

It can be purchased without a prescription. Applying it to the affected areas twice a day yields the best results. Minoxidil increases the blood flow and stimulates hair follicles, which subsequently promotes hair growth. This takes time. So, patience is a critical virtue while using topical alopecia treatment. Minoxidil is safe and is recommended for use in individuals with low-grade alopecia areata. 

Adverse effects:

  • Dizziness
  • Vomiting 
  • Temporary inflammation
  • Nausea
  • Fatigue
  • Change in hair colour
  • Pain in the breasts

Anthralin

Anthralin is another topical alopecia treatment option. It works by irritating the surface of your skin to hasten hair growth. It needs to be applied consistently for the best results. This method is known as topical immunotherapy and is highly effective for hair regrowth.

Adverse effects:

  • Itching
  • Rash on the scalp

Corticosteroids

Creams containing Corticosteroids are another widely used method of managing the condition. These medicines fight the responses of your immune system and counter the effects of autoimmune disease, which thereon allows hair to grow. There are various routes of administering these medicines like topical, oral, and parenteral. 

Adverse effects:

  • Mood swings
  • Nausea
  • Fatigue
  • Water retention
  • Lack of sleep
  • Weight gain
  • GI problems

Oral medications

Taking medicines orally is another way of treating alopecia areata. Dermatologists prescribe Cortisone tablets to manage severe alopecia areata, which reduces the local immune reaction that takes place in this condition. However, these tablets pose an increased possibility of adverse reactions.

Tablets like methotrexate, cyclosporine, and other immunosuppressants are also used for treatment because of the autoimmune nature of the condition. These medicines function by inhibiting your system’s immune response. However, they can’t be taken for prolonged periods due to the increased risk of reactions to them. 

Adverse effects:

  • Headaches
  • Nausea
  • GI problems
  • High blood pressure
  • Damage to the liver
  • Renal damage
  • Elevated risks of serious infections
  • High risk of lymphoma

Injections

Delivery of medicines via the parenteral route or injections is a way of managing low-grade, patchy alopecia areata and aids hair growth on balding patches. It works by injecting steroids into the affected area using tiny needles to stimulate hair growth.

This needs to be done once in one or two months to yield the best results. However, there is no guarantee that there will not be renewed loss of hair.

Adverse effects:

  • Pain or discomfort
  • Bruising 
  • Swelling in the injection area
  • High blood pressure
  • Insomnia
  • Mood swings

Light therapy

This is a kind of radiation therapy that utilizes a mix of tablets known as psoralens and ultraviolet light to treat Alopecia areata. It is also called ‘photochemotherapy’. It helps by stimulating melanogenesis, suppressing the immune system, and promoting growth factors.

The method is backed by scientific studies and has the potential to be used as an alternative for oral and invasive alopecia treatment. It is gaining popularity due to the increasing number of people avoiding other therapies. 

Adverse effects:

  • Rashes on the skin
  • Headaches
  • Nausea
  • Strain on the eyes
  • Sweating

Current trends

Research is on to assess the use of quercetin for treating alopecia areata. Quercetin is a bioflavonoid present in some fruits and vegetables that inhibits the developmental progress of the condition. It is also useful in treating hair loss. The research, however, is still in its nascent stages, and proper human clinical trials are needed before it can be considered a viable option to treat Alopecia areata.

Home Remedies: Do they work for Alopecia Areata?

In-depth research and personal anecdotes shared over generations indicate that certain home remedies are useful in alopecia treatment. It must be noted, however, that there is not much scientific evidence to prove their efficacy. Such remedies do not have the consensus of many dermatologists. Their success varies from one person to another. And in certain cases, the individual may even experience long-term side-effects. That said, here’s a list of the most popularly-used home remedies for Alopecia:

Onion juice

According to several studies and documented personal experiences, applying onion juice on your scalp boosts hair growth. It contains high levels of dietary sulfur; sulfur is found in components of protein, which is known to be quite beneficial for the growth and strength of hair. For one, sulfur promotes blood circulation. Also, it increases collagen production.

But remember, like every other therapy, this may work well for some and not at all for others.

Korean red ginseng

One of the most popular home remedies for Alopecia is Korean Red Ginseng, a herb that treats several other conditions. It has been observed to stimulate hair regrowth in people suffering from Alopecia.

Aromatherapy

Massaging your scalp with essential oils regularly boosts hair growth. Rosemary, thyme, lavender, and cedarwood have displayed efficacy in boosting regrowth in cases of Alopecia. Additional research on the effects of these oils on alopecia patients is necessary.

De-stressing

Stress is a major trigger for the onset of alopecia areata. Hence, managing your stress levels is essential. Meditation, yoga, and indulging in activities that are not stressful will help.

Scalp massages

A good hair massage can help relieve your stress and also stimulate hair growth by increasing the blood supply to your follicles. It gives follicles the power to produce hair. Be sure to massage your hair with oil thoroughly in winter to avoid a dry scalp.

Ayurvedic therapy

As per Ayurvedic beliefs, Shirolepa is designed to manage hair loss. The therapy includes scalp massages, followed by packs and the pouring of ayurvedic oils such as amla and Brahmi. It is performed for 21 days. Other therapies such as Prachana, Nasya, and Rasayana are popular treatments for Alopecia

Dietary and lifestyle changes

You are what you eat. Your diet plays a vital role in managing the condition. That is why you need to be watchful of what you consume. Here are some foods you should include in your diet and the foods you need to avoid if you have alopecia areata.

Foods to include in your diet:

Fruits and veggies 

Fruits and vegetables that are vibrantly-coloured are instant mood uplifters. Fruits like apples, strawberries, and watermelons are rich in antioxidants, which controls oxidative stress. In addition, the antioxidant properties also prevent the break-down of hair follicle cells on the scalp by getting rid of free radicals.

Similarly, vegetables such as cauliflower, broccoli, and spinach are also good sources of antioxidants. They help fight swelling in the body and reduce symptoms of the condition.

Onions 

Incorporating onions in your diet help battle inflammation due to their antioxidant-rich nature. As mentioned earlier, onions contain sulfur, which is known to be healthy for hair growth. In addition, they are also very useful for treating several other diseases.

Fish 

Packed with the goodness of omega-3 fatty acids, fish is a very healthy food to include in your diet. Omega-3 fatty acids provide key elements like proteins and nutrients that hair follicles and skin needs for better nourishment. It helps lessen the symptoms of Alopecia, stimulates hair growth, and works wonders for your skin.

Nuts 

These are foods that are rich in omega-3 fatty acids, which, again, is essential for hair follicles to promote healthy hair. Nuts help reduce swelling and manage Alopecia. Incorporating walnuts, almonds, hazelnuts, cashews, etc., can benefit your overall health. 

Oils 

Olive oil is a healthy alternative to regular cooking oils and is full of omega-3 fatty acids. Your nutritionist may ask you to include certain oils and ghee in your diet, along with some herbs, based on their assessment. 

Protein-rich foods 

A diet rich in protein stimulates hair growth. Remember, hair follicles are made of protein. In the absence of this key nutrient, significant hair loss is observed. Specifically, keratin is more beneficial, which gets absorbed by hair cuticles and promotes better hair growth. Consuming eggs, meat, beans, and dals as part of your regular diet can help boost hair re-growth and manage symptoms of Alopecia.

Foods you must avoid eating:

Dairy products

The presence of elements like casein in milk is believed to trigger the immune system. Consuming foods that irritate the immune system may lead to worsening of the symptoms of alopecia areata. It is, therefore, best to avoid dairy products if you have been diagnosed with the condition. 

Fatty foods 

Eating foods that contain high levels of bad fats can worsen the condition. A diet filled with fried and junk foods is to be avoided at all costs. Instead, have foods that are boiled or steamed to get maximum nutritional value out of them.

When to consult a doctor?

All of us shed a little hair time and again. However, seeing the sudden hair fall on your brush or in your drain can cause a rude shock. It is vital that you understand the reason for sudden hair fall. 

Understanding the natural cycles of growth and loss can help determine if you need to visit your dermatologist or not. 

  • The first phase is growth which can last for around three to seven years
  • It is followed by the transition that is about two weeks long
  • The third phase ends in shedding and is about 3-months long

If you observe a consistent amount of hair loss and any of the symptoms above, it is likely that your sudden hair fall has a pathological cause. It is, however, best to consult with your dermatologist before worrying. The condition is manageable and in many cases, can be reversed.

Why choose HairMD?

HairMD, spearheaded by expert dermatologist Dr. Dhananjay Chavan, is a leading transplant centre that boasts a success rate of over 98.32%! We are the best transplant centre in Pune and one of the topmost in the state. With experience of over 28 years in the field, we assure you:

  • The latest global hair transplant technologies
  • Expert care
  • Internationally trained staff
  • Boarding and accommodation facilities for patients from other locations
  • Regular follow-up and support services
  • State-of-the-art technology 

Having successfully treated over 1 lakh patients from different parts of Maharashtra, we are the answer to every patient’s woe of finding the right transplant centre. Take a look at some of our key practices in transplants:

  • Natural hairline replicated hair by hair
  • Packing to ensure maximum density
  • Grade 7 baldness experts

At HairMD, you are assured of a transparent and seamless experience with clarity on costs from day one. The consultations with our team of experts will assure you that you are in safe hands at every step. We work tirelessly towards ensuring every patient leaves our centre with a smile.

We are together in your Journey of defeating Alopecia Areata.

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