Tuesday, 21 May 2019 , 11:52:08

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Alopecia areata

Alopecia Areata is a form of hair loss, usually from the scalp, although it can affect other areas of the body. The hair loss mostly remains limited to the scalp but in certain cases it can extend to eyebrows, eyelashes, facial hair (beard, moustache), nasal hair and give rise to bald spots anywhere in the body.

Alopecia Areata is a common condition which arises largely due to a mix of immunological and hormonal factors. Alopecia Areata can affect both men and women and it is not uncommon to see children affected with this disorder. Approximately 2% of the general population worldwide suffers from Alopecia Areata. We come across many children with Alopecia Areata.

Understanding Alopecia Areata

The hair is made up of a protein called keratin which is also the main constituent of nails. A specialized structure inside the skin called ‘Papilla' produces the hair as shown in the figure. The papilla is surrounded by a sac-like structure called the ‘Hair follicle' which also surrounds rest of the hair root within the skin. The part of the hair outside the skin surface is called as shaft.

Alopecia Areata is considered to be an auto-immune condition in which the immune system of the body (which protects the body from bacteria and viruses) mistakenly attacks the hair follicles and destroys them. This leads to hair loss in the affected area.

The commonest presentation of Alopecia Areata is appearance of bald patches on the scalp. In most cases, hair falls out in small, round patches about the size of a small coin. The patient may have single or multiple such patches. In some cases these patches may remain static, whereas in some cases the patches may spread to involve larger areas of the scalp. In some cases, hair loss is more extensive. Although it is not very common, the disease can progress to cause total loss of hair on the head (Alopecia Areata totalis) or complete loss of hair on the head, face, and rest of the body (Alopecia Areata universalis).

Types of Alopecia Areata:

  • Alopecia Areata monolocularis: In this condition there is a single bald spot on the scalp.
  • Alopecia Areata subtotalisis: In this condition there are multiple bald spot on the scalp.
  • Alopecia Areata totalis: In this condition, the patient loses all the hair on the scalp.
  • Alopecia Areata universalis: In this condition, all body hair, including pubic hair, is lost.

Alopecia areataAlopecia areataAlopecia areata


There is no cure for alopecia areata. A combination of treatments is often the best approach. Treatment usually depends upon how severe the hair loss is and whether it involves only one or two patches or is more extensive. Many advertised treatments have no proven benefit.

Systemic Treatment for Alopecia Areata

Monthly steroid (cortisone) injections are the most common treatment for milder cases and small bald patches. A very small needle is used to inject cortisone into and around the bald areas. The patient may feel a mild tingling sensation during the injection.

New hair growth is usually visible within a few weeks. Injections can initiate new hair growth in bald patches, but don't prevent other patches from developing. Sometimes the injections cause small, temporary depressions in the scalp called dells.

Cortisone pills are sometimes prescribed in patients with more complete hair loss. Patients should be aware that cortisone could cause serious side effects when used for a long period of time. The hair that regrows usually falls out when this treatment stops.

Topical Treatment for Alopecia Areata

The synthetic corticosteroid clobestrol (ointment or cream) and the corticosteroid fluocinonide (cream) are applied to the scalp. They have been used to treat alopecia for years.

Topical minoxidil is applied twice a day to the bald patches, sometimes followed 30 minutes later with an application of cortisone cream. Minoxidil is not effective on severe cases of alopecia. Minoxidil is intended for treatment of hereditary balding only.

Anthralin cream or ointment, a synthetic substance similar to coal tar, has some benefit in treating mild cases of alopecia areata. It is applied to the bare patches once a day and then washed off 30 to 60 minutes later. New hair growth is visible within 8 to 12 weeks. Prolonged treatment with anthralin can cause skin irritation and a temporary brownish discoloration. Some dermatologists prescribe daily anthralin treatment only after monthly steroid injections have proven ineffective

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