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.
What Causes Alopecia Areata?
The exact cause of alopecia areata is not known. Alopecia areata is an autoimmune disease. Normally the immune system protects the body against infection and disease. In an autoimmune disease, the body’s immune system mistakenly attacks some part of your own body. In alopecia areata, the immune system attacks the hair follicles. Scientists suspect that a combination of genes may predispose some people to the disorder. In those who are genetically predisposed, some type of trigger — perhaps a virus or a psychological trauma — may bring on the disorder.
As with other autoimmune disorders, it is believed that a genetic predisposition to the disorder exists and that the disorder is triggered. Triggers may be environmental, dietary, or psychological.
In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.
Is My Hair Loss a Symptom of a Serious Disease?
Alopecia areata is not a life-threatening disease. It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.
The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.
Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.
Can I Pass It On to My Children?
It is possible for alopecia areata to be inherited. However, most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which a child has a 50–50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55-percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.
To learn more about the genes and other factors involved in alopecia areata risk, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) sponsored the development of an alopecia areata registry.
Will My Hair Ever Grow Back?
There is every chance that your hair will grow back, but it may fall out again. No one can tell you when it might fall out or grow back. You may lose more hair, or your hair loss may stop. The hair you have lost may or may not grow back. Even a person who has lost all of his hair may grow all of his hair back. The disease varies from person to person.
There is every chance that your hair will regrow with or without treatment, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on the scalp; some lose all the hair on the scalp, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.
In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.
How Is Alopecia Areata Treated?
There is no cure for alopecia areata. There are no drugs approved to treat it. Doctors may use medicines approved for other diseases to help hair grow back.
However, none of these treatments prevent new patches of hair loss or cure the disease. Talk to your doctor about the treatment that is best for you.
Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Keep in mind that although these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult your health care professional about the best option for you. A combination of treatments may work best. Ask how long the treatment may last, how long it will take before you see results, and about the possible side effects.
In addition to treatments to help hair grow, there are measures that can be taken to minimize the effects of excessive sun exposure or discomforts of lost hair.
- Sunscreens are important for the scalp, face, and all exposed areas.
- Eyeglasses (or sunglasses) protect the eyes from excessive sun and from dust and debris when eyebrows or eyelashes are missing.
- Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.
- An ointment applied inside the nostrils keeps them moisturized and helps to protect against organisms invading the nose when nostril hair is missing.
What Can I Expect Next?
The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease. You may continue to lose hair, or your hair loss may stop. The hair you have lost may or may not grow back, and you may or may not continue to develop new bare patches.
How Will Alopecia Areata Affect My Life?
Alopecia areata does not make you feel pain and does not make you feel sick. You can’t give it to others. People who have the disease are, for the most part, healthy in other ways. Alopecia areata will not shorten your life, and it should not affect activities such as going to school, working, marrying, raising a family, playing sports, and exercising.
This is a common question, particularly for children, teens, and young adults who are beginning to form lifelong goals and who may live with the effects of alopecia areata for many years. The comforting news is that alopecia areata is not a painful disease and does not make people feel sick physically. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy and it should not interfere with going to school, playing sports and exercising, pursuing any career, working, marrying, and raising a family.
The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease, speaking with others who are facing the same problem, and, if necessary, seeking counseling to help build a positive self-image.
How Can I Cope With the Effects of This Disease
Living with hair loss can be hard. There are many things you can do to cope with the effects of this disease, including:
- Learning as much as you can about the disease.
- Talking with others who are dealing with the disease.
- Learning to value yourself for who you are, not for how much hair you have or don’t have.
- Talking with a counselor, if necessary, to help build a positive self-image.
Here are some things you can use to reduce the physical dangers or discomforts of lost hair:
- Use sunscreens for the scalp, face, and all exposed skin.
- Wear eyeglasses (or sunglasses) to protect eyes from sun, and from dust and debris, when eyebrows or eyelashes are missing.
- Wear wigs, caps, or scarves to protect the scalp from the sun and keep the head warm.
- Apply antibiotic ointment inside the nostrils to help keep germs out of the nose when nostril hair is missing.
Here are some things you can do to reduce the disease’s effects on your looks:
- Try wearing a wig, hairpiece, scarf, or cap.
- Use a hair-colored powder, cream, or crayon applied to the scalp for small patches of hair loss to make the hair loss less obvious.
- Use an eyebrow pencil to mask missing eyebrows.
Living with hair loss can be difficult, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.
The key to coping is valuing yourself for who you are, not for how much hair you have or don’t have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. Nearly 2 percent of Americans have this disease at some point in their lives, so you are not alone. If you would like to be in touch with others with the disease, the National Alopecia Areata Foundation (NAAF) can help through its pen pal program, message boards, annual conference, and support groups that meet in various locations nationwide.
Another way to cope with the disease is to minimize its effects on your appearance. If you have extensive hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.
Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child’s interest and mood. It is often helpful if a parent informs teachers, coaches, and others that the child has alopecia areata, that it is not contagious, and that the child is healthy.
For women, attractive scarves can hide patchy hair loss, and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of alopecia areata, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.
What Research Is Being Done on Alopecia Areata?
Although a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to cure it or even prevent it.
The National Institutes of Health (NIH) and other organizations support research into the disease and its treatment. Here are some promising areas of research:
- Developing animal models. This is a critical step toward understanding any disease, and much progress has been made. By studying mice with problems similar to those encountered in human alopecia areata, researchers hope to learn more about the mechanism of the disease and eventually develop treatments for the disease in people.
- Studying hair follicle development. By studying how hair follicles form, develop, and cycle through growth and resting phases, researchers hope to gain a better understanding of hair growth cycle biology that may lead to treatments for the underlying disease process.
- Understanding stem cell biology. Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, scientists hope to gain a better understanding of factors that trigger the disease.
- Finding genes. Scientists have identified genetic variations associated with the development of alopecia areata. They also discovered that alopecia areata has genetic similarities to other autoimmune diseases, namely type 1 diabetes, rheumatoid arthritis, and celiac disease. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies. To assist researchers searching for such genetic clues, the NIAMS supported the development of the National Alopecia Areata Registry, a network of five centers, to identify and register patients with the disease and collect information and blood samples (which contain genes). Data, including genetic information, is made available to researchers studying the genetic basis and other aspects of the disease and disease risk. For more information, log onto the registry website at www.AlopeciaAreataRegistry.org.
Researchers are seeking a better understanding of the disease. Scientists are studying:
- Hair follicle development
- Immune treatments
- Stem cells in the skin