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Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often it results in a few bald spots on the scalp, each about the size of a coin. The disease may cause
psychological stress In psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an occurrence i ...
. People are generally otherwise healthy. In a few cases, all the hair on the scalp is lost (''
alopecia totalis Alopecia totalis is the loss of all skull and facial hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, ...
'') or all body hair is lost (''
alopecia universalis __NOTOC__ Alopecia universalis (AU), also known as alopecia areata universalis, is a medical condition involving the loss of all body hair, including eyebrows, eyelashes, chest hair, armpit hair, and pubic hair. It is the most severe form of alopeci ...
'') and loss can be permanent. Alopecia areata is believed to be an
autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of differe ...

autoimmune disease
resulting from a breach in the
immune privilege Certain sites of the human body have immune privilege, meaning they are able to tolerate the introduction of antigen In immunology Immunology is a branch of biology that covers the study of immune systems in all organisms. Immunology charts, ...
of the
hair follicles The hair follicle is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given org ...

hair follicles
. Risk factors include a family history of the condition. Among
identical twins Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two emb ...
, if one is affected, the other has about a 50% chance of also being affected. The underlying mechanism involves failure by the body to recognize its own cells with subsequent immune mediated destruction of the
hair follicle The hair follicle is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given org ...

hair follicle
. No cure for the condition is known. Efforts may be used to try to speed hair regrowth such as
cortisone Cortisone is a pregnane (21-carbon) steroid hormone. Cortisone is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of ...

cortisone
injections.
Sunscreen Sunscreen, also known as sunblock or suntan lotion, is a photoprotective topical A topical medication is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug use ...
, head coverings to protect from cold and sun, and
glasses Glasses, also known as eyeglasses or spectacles, are vision eyewear, consisting of glass or hard plastic lenses mounted in a frame that holds them in front of a person's eyes, typically utilizing a bridge over the nose and hinged arms (known ...

glasses
if the
eyelashes An eyelash (also called lash) (Latin: ''Cilia'') is one of the hairs that grows at the edge of the eyelids. It grows in one layer on the edge of the upper and lower eyelids. Eyelashes protect the eye from debris, dust and small particles and pe ...

eyelashes
are missing are recommended. In some cases, the hair regrows and the condition does not reoccur. In others, hair loss and regrowth occurs over years. Among those in whom all body hair is lost, less than 10% recover. About 0.15% of people are affected at any one time and 2% of people are affected at some point in time. Onset is usually in childhood. Males and females have the condition in equal numbers. The condition does not affect a person's
life expectancy Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age, and other demographic Demography (from prefix ''demo-'' from Ancient Greek Ancien ...

life expectancy
.


Signs and symptoms

Typical first symptoms of alopecia areata are small bald patches. The underlying skin is unscarred and looks superficially normal. Although these patches can take many shapes, they are usually round or oval. Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair. Different areas of the skin may exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. It is common in children. The area of hair loss may tingle or be painful.American Osteopathic College of Dermatology
Alopecia Areata.
Dermatologic Disease Database. Aocd.org. Retrieved on December 3, 2007.
The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other. Exclamation point hairs, narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance, are often present.Zoe Diana Draelos (August 30, 2007)

. MedicineNet.com. Retrieved on December 2, 2007
These hairs are very short (3–4 mm), and can be seen surrounding the bald patches. When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata, hair tends to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy. Nails may have pitting or trachyonychia.


Causes

Alopecia areata is thought to be a systemic autoimmune disorder in which the body attacks its own anagen
hair follicle The hair follicle is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given org ...

hair follicle
s and suppresses or stops hair growth. For example,
T cell A T cell is a type of lymphocyte A lymphocyte is a type of white blood cell in the immune system The immune system is a network of biological processes that protects an organism In biology, an organism (from Ancient Greek, Greek: ...
lymphocytes A lymphocyte is a type of white blood cell in the immune system of gnathostomata, jawed vertebrates. Lymphocytes include natural killer cells (which function in cell-mediated immunity, cell-mediated, cytotoxicity, cytotoxic innate immune system, i ...

lymphocytes
cluster around affected follicles, causing inflammation and subsequent hair loss. Hair follicles in a normal state are thought to be kept secure from the immune system, a phenomenon called immune privilege. A breach in this immune privilege state is considered as the cause of alopecia areata. A few cases of babies being born with
congenital A birth defect, also known as a congenital disorder, is a condition present at birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiat ...
alopecia areata have been reported. Alopecia areata is not
contagious Contagious may refer to: * Contagious disease Literature * Contagious (magazine), a marketing publication * Contagious (novel), ''Contagious'' (novel), a science fiction thriller novel by Scott Sigler Music Albums *Contagious (Peggy Scott-Adams ...
. It occurs more frequently in people who have affected family members, suggesting
heredity Heredity, also called inheritance or biological inheritance, is the passing on of Phenotypic trait, traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cell (biology), cells or or ...

heredity
may be a factor. Strong evidence of genetic association with increased risk for alopecia areata was found by studying families with two or more affected members. This study identified at least four regions in the genome that are likely to contain these genes. In addition, alopecia areata shares genetic risk factors with other autoimmune diseases, including
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...
,
type 1 diabetes Type 1 diabetes (T1D), previously known as juvenile diabetes, is an autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response An immune response is a reaction which occurs within an organism for the purp ...
, and
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
. It may be the only manifestation of celiac disease. Endogenous
retinoid The retinoids are a class of chemical compounds A chemical compound is a chemical substance A chemical substance is a form of matter In classical physics and general chemistry, matter is any substance that has mass and takes up space ...
s metabolic defect is a key part of the pathogenesis of the alopecia areata. In 2010, a genome-wide association study was completed that identified 129 single nucleotide polymorphisms that were associated with alopecia areata. The genes that were identified include those involved in controlling the activation and proliferation of regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, and Eos (also known as Ikaros family zinc finger 4), as well as the human leukocyte antigen. The study also identified two genes, ''PRDX5'' and ''STX17'', that are expressed in the hair follicle.


Diagnosis

Alopecia areata is usually diagnosed based on clinical features.
Trichoscopy Trichoscopy is a method of hair and scalp evaluation and is used for diagnosing hair and scalp diseases. The method is based on dermoscopy. In trichoscopy hair and scalp structures may be visualized at many-fold magnification. Currently magnificati ...
may aid in establishing the diagnosis. In alopecia areata, trichoscopy shows regularly distributed "yellow dots" ( hyperkeratotic plugs), small exclamation-mark hairs, and "black dots" (destroyed hairs in the hair follicle opening). Oftentimes, however, discrete areas of hair loss surrounded by exclamation mark hairs is sufficient for clinical diagnosis of alopecia areata. Sometimes, reddening of the skin,
erythema Erythema (from the Greek ''erythros'', meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythe ...
, may also be present in the balding area. A biopsy is rarely needed to make the diagnosis or aid in the management of alopecia areata.
Histologic Histology, also known as microscopic anatomy or microanatomy, is the branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Mol ...
findings may include peribulbar lymphocytic infiltration resembling a "swarm of bees", a shift in the
anagen The hair follicle is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given org ...
-to-telogen ratio towards telogen, and dilated follicular infundibulae. Other helpful findings can include pigment incontinence in the hair bulb and follicular stelae. Occasionally, in inactive alopecia areata, no inflammatory infiltrates are found.


Classification

Commonly, 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. * Ophiasis refers to hair loss in the shape of a wave at the circumference of the head. * The disease may be limited only to the beard, in which case it is called alopecia areata barbae. * If the person loses all the hair on the scalp, the disease is then called alopecia areata totalis. * If all body hair, including
pubic hair Pubic hair is terminal body hair that is found in the genital area of adolescent and adult humans. The hair is located on and around the sex organs and sometimes at the top of the inside of the thighs. In the pubic region around the pubis ...

pubic hair
, is lost, the diagnosis then becomes alopecia areata universalis. Alopecia areata totalis and universalis are rare.Skin Conditions: Alopecia Areata
. WebMD. Retrieved on December 2, 2007.


Treatment

The objective assessment of treatment efficacy is very difficult and spontaneous remission is unpredictable, but if the affected area is patched, the hair may regrow spontaneously in many cases. None of the existing therapeutic options are curative or preventive. In cases of severe hair loss, limited success has been achieved by using the
corticosteroid Corticosteroids are a class of steroid hormone A steroid hormone is a steroid A steroid is a biologically active organic compound In , organic compounds are generally any s that contain - . Due to carbon's ability to (form chains w ...
medications or
fluocinonide Fluocinonide (sold under various trade names) is a potent glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that ...

fluocinonide
, corticosteroid injections, or cream. Application of corticosteroid creams to the affected skin is less effective and takes longer to produce results. Steroid injections are commonly used in sites where the areas of hair loss on the head are small or especially where eyebrow hair has been lost. Whether they are effective is uncertain. Some other medications that have been used are
minoxidil Minoxidil (2,4-diamino-6-piperidinopyrimidine 3-oxide), sold under the brand name Rogaine among others, is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to ...

minoxidil
, Elocon (mometasone) ointment (steroid cream), irritants ( anthralin or topical
coal tar Coal tar is a thick dark liquid which is a by-product of the production of coke and coal gas Coal gas is a flammable gaseous fuel Fuel gas is any one of a number of fuels that under ordinary conditions are gaseous. Many fuel gases are c ...
), and topical immunotherapy
ciclosporin Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications are drugs that inhibit or prevent activity o ...

ciclosporin
, sometimes in different combinations. Topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target, and small lesions typically also regrow spontaneously. Oral corticosteroids may decrease the hair loss, but only for the period during which they are taken, and these medications can cause serious
side effects In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences ...
. No one treatment is effective in all cases, and some individuals may show no response to any treatment. Few treatments have been well evaluated. A 2008
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies The scientific method is an Empirical evidence, empirical method of acquiring knowledge that has characterized the development of science s ...
of oral and topical corticosteroids, topical ciclosporin, photodynamic therapy, and topical minoxidil showed no benefit of hair growth compared with placebo, especially with regard to long-term benefits. For more severe cases, recent studies have shown promising results with the individual use of the immunosuppressant Methotrexate or adjunct use with corticosteroids. However, as relapse of the condition may occur long-term treatment is recommended. When alopecia areata is associated with
celiac disease Coeliac disease or celiac disease is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any bo ...
, treatment with a
gluten-free diet A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten Gluten is a protein naturally found in some grains including wheat, barley, and rye. Although, strictly speaking, "gluten" pertains only to wheat proteins, in the ...
allows for complete and permanent regrowth of scalp and other body hair in many people, but in others, remissions and recurrences are seen. This improvement is probably due to the normalization of the
immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, Parasitism, parasites, and Fungus ...

immune response
as a result of
gluten Gluten is a protein naturally found in some grains including wheat, barley, and rye. Although, strictly speaking, "gluten" pertains only to wheat proteins, in the medical literature it refers to the combination of prolamin Prolamins are a group ...

gluten
withdrawal from the diet.


Prognosis

In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia areata totalis or, in rare cases, alopecia areata universalis. No loss of body function occurs, and the effects of alopecia areata are psychological (loss of self-image due to hair loss), although these can be severe. Loss of hair also means the scalp burns more easily in the sun. Patients may also have aberrant nail formation because
keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin Alpha-keratin, or α-keratin, is a type of keratin Keratin () is one of a family of fibrous structural proteins known as Scleroprot ...

keratin
forms both hair and nails. Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Episodes of alopecia areata before puberty predispose to chronic recurrence of the condition. Alopecia can be the cause of psychological stress. Because hair loss can lead to significant changes in appearance, individuals with it may experience
social phobia Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental p ...
,
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...

anxiety
, and
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
.


Epidemiology

The condition affects 0.1%–0.2% of the population, and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders. Initial presentation most commonly occurs in the early childhood, late
teenage Adolescence ()''Macmillan Dictionary for Students'' Macmillan, Pan Ltd. (1981), page 14, 456. Retrieved July 15, 2010. is a transitional stage of Developmental biology, physical and psychological Human development (biology), development that ...
years, or young adulthood, but can happen at any ages. Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as
asthma Asthma is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based in Greenwich, ...

asthma
, allergies,
atopic Atopy is the tendency to produce an exaggerated immunoglobulin E Immunoglobulin E (IgE) is a type of antibody An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and ...
dermatitis, and
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two ...

hypothyroidism
.


Research

Many medications are being studied. Some of these medications are approved for other diseases, others are not available outside of studies. In 2014, preliminary findings showing that oral
ruxolitinib Ruxolitinib, sold under the brand names Jakafi and Jakavi, is a medication A medication (also referred to as medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or ...

ruxolitinib
, a drug approved by the US Food and Drug Administration (
FDA The United States The United States of America (USA), commonly known as the United States (U.S. or US), or America, is a country Contiguous United States, primarily located in North America. It consists of 50 U.S. state, states, a Wash ...
) for bone marrow disorder
myelofibrosis Primary myelofibrosis (PMF) is a rare bone marrow Bone marrow is a semi-solid tissue found within the spongy or cancellous portions of bone A bone is a Stiffness, rigid tissue (anatomy), tissue that constitutes part of the vertebrate skele ...
, restored hair growth in three individuals with long-standing and severe disease. The medicine costs almost US$10,000 a month.


History

Alopecia areata and alopecia barbae have been identified by some as the biblical condition that is part of the greater family of skin disorders; the said disorders are purported to being discussed in the
Book of Leviticus The Book of Leviticus () is the third book of the Torah Torah (; he, תּוֹרָה, "Instruction", "Teaching" or "Law") has a range of meanings. It can most specifically mean the first five books (Pentateuch or Five Books of Moses) of ...
, chapter 13. Notable people with alopecia areata include actor Anthony Carrigan, athlete of
American Ninja Warrior ''American Ninja Warrior'' (sometimes abbreviated as ''ANW'') is an American sports entertainment Sports entertainment is a type of spectacle which presents an ostensibly competition, competitive event using a high level of theatre, theatrical ...
fame Kevin Bull, congresswoman
Ayanna Pressley Ayanna Soyini Pressley (born February 3, 1974) is an American politician who is serving as the U.S. Representative for Massachusetts's 7th congressional district since 2019. Her district includes the northern three quarters of Boston Boston ...
and Pittsburgh Steelers quarterback
Joshua Dobbs Robert Joshua Dobbs (born January 26, 1995) is an American football American football, referred to simply as football in the United States and Canada and also known as gridiron, is a team sport played by two teams of eleven players on a r ...
.


See also

*
Noncicatricial alopecia Non scarring hair loss, also known as noncicatricial alopecia is the loss of hair without any scarring being present.James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ...
*
Trichotillomania Trichotillomania (TTM), also known as hair-pulling disorder or compulsive hair pulling, is a mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significan ...

Trichotillomania


References


External links


National Institute of Arthritis and Musculoskeletal and Skin Diseases
at
NIH The National Institutes of Health (NIH ) is the primary agency of the United States government The federal government of the United States (U.S. federal government or U.S. government) is the national government of the United States ...
* {{DEFAULTSORT:Alopecia Areata Autoimmune diseases Conditions of the skin appendages Human hair Hair diseases Wikipedia medicine articles ready to translate RTTNEURO