Alopecia areata is a type of hair loss that is different to age related hair loss including male pattern or female pattern hair loss. This type of hair loss is the most common autoimmune disease. It is more common than rheumatoid arthritis, thyroiditis and insulin dependent diabetes.
Alopecia areata affects people in all age groups, including young children. This type of hair loss is characterised by circular patches of hair loss that can appear overnight. Over time more circular patches appear. About 5% of people who have alopecia areata will lose hair on every part of their body, including their eyelashes, nose hairs and eyebrows. For some people, hair can grow back in the same place or on a different part of the body or scalp.
While it is baffling that most people have never heard about the most common autoimmune disease, it is also understandable. This hair loss disease can be very distressing and embarrassing. Boys that have alopecia areata can find it so disturbing that they commit suicide.
Because this disease has cycles, it can flare up and then dissipate. People with alopecia areata tend to disguise it well with different hairstyles or cosmetics. In severe cases of alopecia areata, it can be mistaken for the type of hair loss seen after chemotherapy treatment.
The causes of alopecia areata
Alopecia areata arises when the body’s immune system attacks the hair follicles as if they were foreign, causing the hairs to fall out. In the early stages it tends to come and go, suggesting environmental triggers may play a part. Trying to find the elusive trigger to alopecia areata has led some people to modify their diet and lifestyle. And while it is suggested that stress may play a role, in my experience of treating patients alopecia areata causes their stress.
This autoimmune hair loss disease can be inherited from either parent. It is classified as a ‘complex polygenic disease’ because it is the result of multiple genes interactions. There are 17 genes associated with alopecia areata, with more being discovered.
Current treatment for alopecia areata
For the past 40 years the treatment options for alopecia areata have been the same. In mild cases cortisone injections in the bald scalp have suppressed inflammation and halted the white blood cells from attacking hair follicles. This creates an environment where hair can regrow.
Anti inflammatory tablets or cortisone tablets can also be used to treat alopecia areata. It is important to note that the side effects of this treatment can include mood disturbance, diabetes, hypertension, weight gain and increased infection risks.
Severe cases of alopecia areata that result in every hair on the body vanishing (alopecia areata universalis) or a completely bald scalp (alopecia areata totalis) will rarely recover without treatment. These severe types of hair loss tend to be long lasting and permanent. In cases like this, the only option for many people is to wear a wig.
Future treatments of alopecia areata
Research has shown that some of the 17 genes connected with alopecia areata are involved in an inflammatory pathway named JAK/STAT. Drugs that target the JAK/STAT pathway are in development or available. These prescription drugs are known as JAK inhibitors or JAK’s and are available in USA, Europe and Australia to treat myelofibrosis and rheumatoid arthritis. While these drugs are not yet approved to treat alopecia areata in Australia, clinical trials are underway to find out the benefit of JAK’s for alopecia areata patients. So far the side effects of JAK inhibitors include:
- An increase in skin and chest infections,
- Transaminaitis (a liver function alteration that is identified by blood tests)
- Stomach upsets
While up to 25% of patients report mild skin and upper respiratory tract infections, very few patients on the trial choose to stop taking the medication.
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