Alopecia areata is a condition that causes a person’s hair to fall out. It is an autoimmune disease; that is, the person’s immune system attacks their body, in this case, their hair follicles. When this happens, the person’s hair begins to fall out, often in clumps the size and shape of a quarter. The extent of the hair loss varies; in some cases, it is only in a few spots. In others, the hair loss can be greater.

On rare occasions, the person loses all of the hair on his or her head (alopecia areata totalis) or entire body (alopecia areata universalis). Alopecia is the medical term for baldness; there are various types of alopecia, including alopecia areata. It is believed that the person’s genetic makeup may trigger the autoimmune reaction of alopecia areata, along with a virus or a substance the person comes into contact with.

Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique. Even if someone loses all of his or her hair, there is a chance that it will grow back.
Who Gets Alopecia Areata?

Anyone can develop alopecia areata; however, your chances of having alopecia areata are slightly greater if you have a relative with the disease. In addition, alopecia areata occurs more often among people who have family members with autoimmune disorders such as diabetes, lupus, or thyroid disease.
Can Alopecia Areata Be Cured?

Alopecia areata cannot be cured; however, it can be treated and the hair can grow back.
In many cases, alopecia areata is treated with drugs that are used for other conditions. Treatment options for alopecia areata include:
Corticosteroids: Anti-inflammatory drugs that are prescribed for autoimmune diseases. Corticosteroids can be given as an injection into the scalp or other areas, orally (as a pill), or applied topically (rubbed into the skin) as an ointment, cream, or foam. Response to therapy may be gradual.
Rogaine: This topical drug is already used as a treatment for pattern baldness. It usually takes about 12 weeks of treatment with Rogaine before hair begins to grow.

Other drugs that are used for alopecia areata with varying degrees of effectiveness include medications used to treat psoriasis and topical sensitizers (drugs that are applied to the skin and cause an allergic reaction that can cause hair growth).
Other Tips

Apart from drug treatments, there are various cosmetic and protective techniques that people with alopecia areata can try. These include:
Using makeup to hide or minimize hair loss
Wearing sunglasses to protect the eyes from the sun and the environment
Wearing coverings (wigs, hats, or scarves) to protect the head from the elements
Reducing stress. Many people with new onset alopecia areata have had recent stresses in life, such as work, family, deaths, surgeries, accidents, etc. However, this has not been proven scientifically as a cause of alopecia areata.

While the disease is not medically serious, it can impact people psychologically. Support groups are available to help people with alopecia areata deal with the psychological effects of the condition. Further information may be found at the National Alopecia Areata Foundation

Male-pattern baldness generally requires no testing. When it occurs in young males without a family history, the physician should question the patient about anabolic steroid use and other drugs. In women with significant hair loss and evidence of virilization, testosterone

and dehydroepiandrosterone sulfate levels should be measured.

The “pull” test helps evaluate diffuse scalp hair loss; gentle traction is exerted on 40 to 60 hairs on at least 3 areas of the scalp, and the number of extracted hairs is counted and examined microscopically. Normally, < 6 telogen-phase hairs should come out. Extraction of > 6 hairs in telogen phase is abnormal and suggestive of telogen effluvium.

The “pluck” test is similar except that hairs are abruptly, painfully extracted. The pluck test helps diagnose a defect of telogen or anagen or an occult systemic disease.

Microscopic examination of hair from either test or from hair cuttings is almost always helpful. Anagen hairs have sheaths attached to their roots; telogen hairs have tiny bulbs without sheaths at their roots. Normally, 85 to 90% of hairs are in the anagen phase; about 10 to 15% are in telogen phase; and < 1% are in catagen phase. Telogen effluvium shows an increased percentage of telogen hairs, whereas anagen effluvium shows a decrease in telogen hairs and easy breakage. A high percentage of hairs in the catagen phase (a transitional phase between growth and rest) and trichomalacia are pathognomonic for trichotillomania. Primary hair shaft abnormalities, such as trichorrhexis invaginata and monilethrix, are usually obvious on microscopic evaluation of the hair shaft.

Scalp biopsy is indicated when alopecia persists and diagnosis is in doubt; biopsy may differentiate scarring from nonscarring forms. Specimens should be taken from an area of active inflammation, ideally at the border of a bald patch. Fungal and bacterial cultures may be useful; immunofluorescence studies may help identify lupus erythematosus, lichen planopilaris, and systemic sclerosis.

Daily hair counts can be performed by the patient to quantify hair loss when the pull test is negative. Scalp hair counts of > 100 are abnormal except after shampooing, when hair counts of up to 250 may be normal. Hairs may be brought in by the patient for microscopic examination of hair shafts and bulbs.Nuestros socios:tamano del pene comprar viagra

Male-pattern baldness (androgenetic alopecia) is common, familial, and androgenetic. Hair loss begins at the temples and/or vertex and can spread to diffuse thinning or nearly complete loss. Female-pattern baldness is hair thinning in the frontal, parietal, and crown regions. This too is androgenetic.
Alopecia (Female Pattern)
Telogen effluvium refers to loss of scalp hair caused by synchronicity of hair cycle so that many hairs enter the resting or telogen phase at once. At the end of this resting phase, usually several months after the inciting event, a significant increase in hair shedding is noticed. Drugs are a common cause, especially antiproliferative chemotherapeutic agents, warfarin.
Other drugs that can precipitate telogen effluvium are fluorobutyrophenone, clofibrate,bezafibrate, trimethadione , valproate, captopril, penicillamine, ibuprofen,interferon, ranitidine, sulindac, tamoxifen, terfenadine, and thiamphenicol.
Telogen effluvium is also common with nutritional deficiencies, after physiologic or psychologic stress (surgery, systemic illness), and with pathologic (hypothyroidism or hyperthyroidism) or physiologic (postpartum, menopause) endocrine changes.

Anagen effluvium refers to loss of scalp hair in its growth (or anagen) phase. Radiation and chemotherapeutic agents are the most common causes, but it can occur with mercury, thallium, boric acid, and vitamin A poisoning.

Primary hair shaft abnormalities (trichodystrophies) include a variety of disorders that lead to unruly or unusually wooly hair or to fractures of the hair shaft. In trichorrhexis invaginata, hairs have a ball and cup invagination (bamboo hair). This hair abnormality can occur in association with ichthyosis in the rare autosomal recessive Netherton syndrome. Bubble hair, in which bubbles are seen in the hair shaft, may occur with excessive use of hair dryers. Trichonodosis or knotting of hair occurs with excess rubbing or scratching. Monilethrix is an uncommon autosomal dominant condition that causes beaded and very brittle hair.

Other congenital disorders of the hair include wooly hair nevus (tightly coiled hair over all or portions of the scalp), the uncombable hair syndrome (scalp hair that resists all efforts to comb or brush it), trichorrhexis nodosa (hair shafts break easily and broken stumps are present over large portions of the scalp), and trichothiodystrophy (brittle hair from a defect in sulfur metabolism).

Nonscarring focal loss: Common causes include traction alopecia, tinea capitis, trichotillomania, and alopecia areata (see Hair Disorders: Alopecia Areata). Uncommon causes include syphilis and primary hair shaft abnormalities.

Traction alopecia is hair loss primarily at the frontal and/or temporal hairline due to traction from braids, rollers, or ponytails. Tinea capitis, hair shaft infection with Trichophyton tonsurans, is discussed in Fungal Skin Infections: Tinea Capitis; other less common causes of tinea capitis include Microsporum canis , M. audouinii, and T. schoenleinii. Trichotillomania—focal hair loss due to hair pulling, twisting, or teasing—is symptomatic of an obsessive-compulsive disorder (see Anxiety Disorders: Obsessive-Compulsive Disorder (OCD)).

Late secondary syphilis causes hair loss ranging from localized patches to total alopecia. It may follow the distribution of the preceding exanthem. The serology is always positive. Examination reveals focal yellow-red areas with a moth-eaten appearance.

Scarring focal loss: Scarring refers to obliteration of the hair follicle with fibrosis. Scarring loss is most often due to unusual primary disorders, such as lichen planopilaris (lichen planus of the scalp), folliculitis decalvans (an idiopathic scarring alopecia associated with pustules and intact hairs clumped in a “tufted” pattern), and pseudopelade of Brocq (a particular pattern of scarring alopecia). Other causes include burns, trauma, radiation therapy, severe primary (kerion) or secondary (syphilis) infections, sarcoidosis, lupus erythematosus, and skin malignancy.Nuestros socios: tratamiento impotencia tratamiento eyaculacion

Alopecia areata totalis presents itself as total loss of hair on the scalp

In all forms of alopecia areata, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years.

Treatment Options
While there is no Food & Drug Administration (FDA) approved treatment for alopecia areata, some medical professionals will treat your alopecia areata off-label. However, fewer treatment options are available for extensive alopecia areata (greater the 50% scalp hair loss).

Cortisone pills: Cortisone pills are sometimes given for extensive scalp hair loss. Cortisone taken internally is much stronger than local injections of cortisone into the skin. It is necessary to discuss possible side effects of cortisone pills with your physician. Healthy young adults often tolerate cortisone pills with few side effects. In general, however, cortisone pills are used in relatively few patients with alopecia areata due to health risks from prolonged use. Also, regrown hair is likely to fall out when the cortisone pills are stopped.

Topical Immunotherapy: Another method of treating extensive alopecia areata or alopecia totalis/universalis is known as topical immunotherapy and it involves producing and allergic rash or allergic contact dermatitis. Chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB), or squaric acid dibutyl ester (SADBE) are applied to the scalp to produce an allergic rash which resembles poison oak or ivy. Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment. Those who do successfully regrow scalp hair still need to continue the treatment to maintain the hair regrowth, at least until the condition turns itself off. An itchy rash may be uncomfortable in very hot weather, especially under a wig. These treatments are not available everywhere in the United States although they are used frequently in Canada and Europe.

Wigs: In general, treatments are much less effective for extensive alopecia areata (particularly alopecia totalis/universalis). For this reason, an attractive wig is an important option for some people. Proper attention will make a quality wig look completely natural; every wig has to be cut, thinned and styled, often several times. To keep a net base wig from falling off, even during active sports, special double sided tape can be purchased in beauty supply outlets and fastened to the inside of the wig.For those with completely bare heads, there are suction caps to which any wig can be attached and there are entire suction cap wig units. These state of the art wigs, which make use of a silicon base to create a secure vacuum-fit, are comfortable and easily removed by the wearer. Proper fit of a vacuum wig requires that any existing scalp hair be shaved. These wigs are generally more expensive.

Children under the age of five react very little to their alopecia areata, having very little impact if any. The preschool child is so busy exploring their world, acquiring skills, and gaining independence, that his appearance is virtually immaterial to himself and his peers. His hairloss may be an interesting anomaly, and nothing more. And, most likely his peers will not take much notice to this difference.

Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). However, patients also tend to have a slightly higher incidence of asthma, allergies, atopic dermal ailments, and even hypothyroidism. Loss of hair also means that the scalp burns more easily in the sun. Loss of nasal hair increases severity of hay fever and similar allergic conditions. Patients may also have aberrant nail formation because keratin forms both hair and nails.

Episodes of alopecia areata before puberty predispose chronic recurrence of the condition. Pitting of the fingernails can hint at a more severe or prolonged course.

Hair may grow back and then fall out again later.

Psychosocial issues

Alopecia can certainly be the cause of psychological stress. Because  hair loss can lead to significant appearance changes, individuals may experience social phobia, anxiety, and depression. In severe cases where the chance of hair regrowth is slim, individuals need to adapt to the condition, rather than look for a cure. There is currently little provision for psychological treatment for people afflicted with alopecia.

The most common type of alopecia areata involves hair loss in one or more round spots on the scalp.
Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.
Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.
Alopecia areata multilocularis refers to multiple areas of hair loss.
The disease may be limited only to the beard, in which case it is called Alopecia areata barbae.
If the patient loses all the hair on his/her scalp, the disease is then called Alopecia areata totalis.
If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia areata universalis.
Alopecia areata totalis and universalis are rare.

Epidemiology

The condition affects 0.1%–0.2% of humans, occurring in both males and females.

Alopecia areata occurs in people who are apparently healthy and have no skin disorder. Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen with people of all ages.

Prognosis of Alopecia Areata
The progress of alopecia areata is unpredictable. Some people lose hair in only a small patch. Others may have more extensive involvement. Alopecia totalis is the loss of 100% of scalp hair. Alopecia universalis is the loss of 100% of body hair. These last two conditions are rare. In the majority of patients, the hair will regrow completely within 1 year without any treatment.

Other Hair Loss Conditions
Other diseases that may be mistaken for alopecia areata include:
Telogen effluvium – generalized hair loss caused by pregnancy, certain drugs, high fever, or stress.
Androgenic alopecia – also known as male-pattern baldness.
Trichotillomania – manually pulling the hair out caused by a psychological disorder.
Secondary syphilis – causing a “moth-eaten” baldness pattern over the entire scalp.

Treatment of Alopecia Areata
There are several different treatment options for alopecia areata. The most common is observation. If the patch of hair loss is small, it is reasonable to observe it and allow the hair to regrow on its own. Another option is applying a strong topical steroid such as Diprolene or Temovate to the patch. It may take several months for the hair to grow back using this method. Another common therapeutic option is injection of a steroid, such as Celestone into the involved scalp skin. Initial regrowth of hair can be seen in 4-8 weeks and treatments are repeated every 4-6 weeks. The main side effect from any steroid use is thinning of the skin.

Minoxidil has been used to promote hair growth and has shown cosmetically acceptable results in 30% of cases. Minoxidil does not stop the disease process so stopping applications after hair has started to grow back may cause the hair to fall out again.

Another type of treatment is designed to produce a contact dermatitis, or irritation, at the site seemingly stimulating hair growth. The most common irritant used is called anthralin. Some studies suggest using minoxidil and anthralin in combination may be more effective.

Finally, as a measure when “all else fails”, PUVA may be used as a treatment. PUVA is also known as photochemotherapy. It involves taking a type of drug called psoralens (P) about 2 hours before measured exposure to long-wave ultraviolet light (UVA). This treatment is used most commonly in severe cases of psoriasis. The initiation of hair regrowth may take 40-80 treatments and complete regrowth up to 1-2 years.