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Alopecia Areata

What is alopecia areata?

Alopecia areata is an autoimmune disease that affects the hair on the head and body.  The hair loss may be limited to one area or may lead to complete loss of hair. It occurs in 1-2% of the population with equal frequency in both sexes, and more recently it occurs quite frequently in children and adolescents.

Alopecia areata can have psychologically devastating consequences, such as depression or fear of social exclusion. It occurs in flares and remissions, with stress being a major factor.

It may co-exist with other autoimmune diseases such as:

  • vitiligo
  • Hashimoto’s thyroiditis
  • Addison’s disease
  • autoimmune polyendocrinopathy
  • atopic dermatitis
  • Down’s syndrome

Other factors that lead to the development of alopecia areata are:

  • Long-term stress
  • Infection
  • Hormonal disorders
  • Allergic reactions
  • Seasonal changes

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What are the symptoms of alopecia  areata?

The skin affected by alopecia areata appears normal. Alopecia areata is usually found in the hair, beard and anywhere else there are hairs on the body. The disease is predominantly asymptomatic, however it may present with itching or slight pain.

The disease can often resolve on its own or stabilise with the possibility of reactivation at some point. The hairs thin and disappear over a short period of time. However, cases have been observed where the patient has lost all of his hair and all of his body hair and this is called alopecia universalis.

Risk factors

If a family member has had alopecia areata  in the past there is a high chance that another family member will also be affected due to a genetic predisposition to the disease.

How is the disease diagnosed?

The doctor,  after taking a complete medical history of the patient, will perform a clinical evaluation of the problem. He will then refer him for a trichogram or trichoscopy to define the  the problem. More rarely, a skin biopsy is performed. A characteristic feature of the disease on trichoscopy is exclamation mark-like hairs, i.e. short hairs thinner at the base and thicker at the free end. Another clinical feature of the disease which indicates the possibility of extension of lesions and the ‘opening’ of existing lesions is, during the pulling test, a pronounced hair loss at the periphery of the lesions.

What is the appropriate treatment for alopecia areata?

In general, the treatment of the disease is a challenge for the modern dermatologist because of the intense difficulty in both inhibiting the expansion of hair loss and re-growth of hair in the already formed gaps. There are several ways to treat alopecia areata, which have different results and do not work in the same way in everyone.

More specifically, the treatment methods are as follows:

  • topical or systemic treatment with corticosteroids either in the form of a cream, or in the form of infiltrations with cortisone injections. In cases of severe hair loss leading to universal alopecia pedis, cortisone is administered orally in the form of tablets or even intravenously in high doses.
  • Local administration of minoxidil, which is a safe treatment.
  •  Systemic administration of cyclosporine is effective if given in high doses. It can be co-administered with cortisone.
  • Anthralin. Which causes allergic contact dermatitis. Apply twice a week for 10-20 minutes.
  • Photodynamic therapy
  • Hair transplantation, in cases where the disease is stable for too many years.
  • PRP. Blood platelets are known to contain growth factors which act favourably on the disease.
  • Laser LLLT
  • Psychotherapy and antidepressant therapy.
  • Homeopathy

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