For our third Q&A session, we had the pleasure of interviewing Trisha Repp Benzing. Please take a moment to read Trisha’s courageous journey with alopecia.
Q. When were you diagnosed?
I was diagnosed at 19. My hairdresser found a small spot on the back of my head. I went to my dr who referred me to a dermatologist. Within 30 days half of my hair was gone. I think the stress of the diagnosis increased the speed of the hair loss. I was devastated. At that age, appearance is very important. I had severe depression for a while, which didn’t help either. My friends and husband eventually helped me realize I was beautiful with or without my hair, but it was a rough time for me. Read more…
A number of treatments can help hair regrow but none alter the long-term course of the disorder. Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (< 1 year) making it difficult to assess efficacy, particularly in mild forms of alopecia areata.
Some trials have been limited to patients with severe alopecia areata where spontaneous remission is unlikely. However, these patients tend to be resistant to all forms of treatment and the failure of a treatment in this setting does not exclude efficacy in mild alopecia areata. There are numerous case reports and uncontrolled case series claiming response of alopecia areata to diverse treatments. However, few treatments have been subjected to randomized controlled trials and, except for contact immunotherapy, there are few published data on long-term outcomes.
Topical corticosteroid therapy can be useful, especially in children who cannot tolerate injections. It is administered as follows:
- Fluocinolone acetonide cream 0.2%, betamethasone dipropionate cream 0.05%, or clobetasol 0.05% foam are the most common forms prescribed
- Topical cream or foam should be applied to the affected area and 1 cm beyond the circumference of the bald patch daily
- Treatment must be continued for a minimum of 3 months before regrowth can be expected, and maintenance therapy is often necessary
- For alopecia totalis or alopecia universalis, 2.5 g of clobetasol propionate covered with a plastic film 6 days/wk for 6 months helped a minority of patients
- Side effects include skin atrophy, folliculitis, or telangiectasia
- 28.5%-61% of patients achieve regrowth — 37.5% of patients experience relapse Read more…
A recent study out of Turkey found that in those with alopecia areata, low vitamin D levels are common and may relate to a more severe disease state.
Vitamin D has a well-established effect on the immune system and is linked to a variety of autoimmune diseases. Researchers have found that vitamin D may be able to help in some aspects of autoimmune diseases, such as multiple sclerosis, lupus, and type 1 diabetes. That being said, there hasn’t been any research looking at the relationship between vitamin D and AA.
Recently, researchers at the Şişli Etfal Eğitim ve Araştırma Hastanesi (Training and Research Hospital) in Turkey conducted a study to determine if vitamin D levels relate to AA and how vitamin D may affect disease severity. Read more…
In 1995, the Mayo Clinic released a study on the incidence rate of alopecia areata in Olmsted County, Minnesota consisting of 292 participants who were newly diagnosed with alopecia areata from 1975 to 1989. This study set the only known lifetime risk for alopecia areata at 1.7%. (Lifetime risk means the risk of developing a disease during ones lifetime.) A newer study, with 530 qualifying participants, was recently released accessing the same data parameters but from 1990 to 2009 to document the most current lifetime incidence risk. They found that the risk of a person developing alopecia areata during their lifetime has increased to 2.1%.
Nearly 6.7m people in the U.S. (over 149m worldwide) will develop alopecia areata in their lifetime.
At 2.1%, the cumulative lifetime incidence of AA from this recent 20-year period was slightly higher than 1.7% observed in the older study. Similarly, REP data analyzed in studies of other autoimmune-associated diseases have shown that incidence of rheumatoid arthritis and systemic lupus erythematosis have also increased in the region in recent years. These data do not refute the hypothesis that autoimmune disease incidence maybe rising, generally.
Who Gets Alopecia Areata?
Alopecia areata (AA) affects approximately 2.1% of the population and does not discriminate based on sex or ethnicity. Anyone can have alopecia areata. It often begins in childhood. If you have a close family member with the disease, your risk of developing it is slightly increased. If your family member lost his or her first patch of hair before age 30, the risk to other family members is greater. Overall, one in five people with the disease has a family member who has it as well. Read more…
What is alopecia areata?
Alopecia (al-oh-PEE-shah) areata (ar-ee-AH-tah) is a recurrent nonscarring type of hair loss that occurs when your immune system mistakenly attacks hair follicles, which is where hair growth begins. It can affect any hair-bearing area, may manifest in many different patterns, and more than one area can be affected at once. Frequency of involvement at particular sites is as follows:
- Scalp – 66.8%-95%
- Beard – 28% of males
- Eyebrows – 3.8%
- Extremities – 1.3%
Although it is a benign condition and most patients are asymptomatic, it can cause emotional and psychosocial distress. Self-consciousness concerning personal appearance can become important. Openly addressing these issues through support groups is important in helping them cope with the condition. The damage to the follicle is usually not permanent. Experts do not know why the immune system attacks the follicles. Alopecia areata (AA) is most common in people younger than 20, but children and adults of any age may be affected. Peak incidence appears to occur from age 15-29 years. As many as 44% of people with alopecia areata have onset at younger than 20 years. Onset in patients older than 40 years is seen in less than 30% of patients with alopecia areata. Data concerning the sex ratio for alopecia areata vary slightly in the literature. In one study including 736 patients, a male-to-female ratio of 1:1 was reported. In another study on a smaller number of patients, a slight female preponderance was seen. This disorder most often occurs in otherwise healthy people. Read more…
The exact pathophysiology of alopecia areata remains unknown. The most widely accepted hypothesis is that alopecia areata is a T-cell–mediated autoimmune condition that is most likely to occur in genetically predisposed individuals.
Much evidence supports the hypothesis that alopecia areata is an autoimmune condition. The process appears to be T-cell mediated, but antibodies directed to hair follicle structures also have been found with increased frequency in alopecia areata patients compared with control subjects. Using immunofluorescence, antibodies to anagen-phase hair follicles were found in as many as 90% of patients with alopecia areata compared with less than 37% of control subjects. Read more…
A large number of patients with alopecia areata still need to be examined to confirm whether an increased prevalence of these conditions exists among patients with alopecia areata. Unfortunately, most studies are performed on small groups; therefore, the data should be interpreted carefully.
Atopic dermatitis is seen in 9-26% of patients with alopecia areata. In the general population, the prevalence of atopic dermatitis in children in temperate developed countries varies from 5-20%. In adults, the prevalence decreases to 2-10%. Some authors have found atopy to be a poor prognostic factor for alopecia areata. Read more…
The natural history of alopecia areata is unpredictable. Extreme variations in duration and extent of the disease occur from patient to patient. Alopecia areata most often is asymptomatic, but some patients (14%) experience a burning sensation or pruritus in the affected area. The condition usually is localized when it first appears. Of patients with alopecia areata, 80% have only a single patch, 12.5% have 2 patches, and 7.7% have multiple patches. No correlation exists between the number of patches at onset and subsequent severity. Alopecia areata most often affects the scalp (66.8-95%); however, it can affect any hair-bearing area. Read more…
A team of investigators led by Columbia University Medical Center has uncovered eight genes that underpin alopecia areata, one of the most common causes of hair loss, as reported in a paper in the July 1, 2010 issue of Nature. Since many of the genes are also implicated in other autoimmune diseases, including rheumatoid arthritis and type 1 diabetes – and treatments have already been developed that target these genes – this discovery may lead to new treatments for the 5.3 million Americans affected by alopecia areata. Read more…