February 7, 2017

Alopecia is the loss of hair. Hair loss can be caused by different reasons, including damage to the hair shaft or follicles. Fungal infections can also cause hair loss.

Alopecia areata is a disease that affects the hair follicles, which are part of the skin from which hairs grow. In most cases, hair falls out in small, round patches about the size of a quarter. Many people with the disease get only a few bare patches. Some people may lose more hair. Rarely, the disease causes total loss of hair on the head or complete loss of hair on the head, face, and body.

Alopecia areata is considered to be an autoimmune disease, where the immune system mistakenly targets the body instead of harmful foreign invaders such as bacteria. In the case of alopecia areata, the immune system attacks the hair follicles which leads to hair loss.

Hair grows in cycles. Each cycle consists of a long growing phase (anagen), a brief transitional apoptotic phase (catagen), and a short resting phase (telogen). At the end of the resting phase, the hair falls out (exogen) and a new hair starts growing in the follicle, beginning the cycle again. Normally, about 50 to 100 scalp hairs reach the end of resting phase each day and fall out. When significantly more than 100 hairs/day go into resting phase, clinical hair loss (telogen effluvium) may occur. A disruption of the growing phase causing abnormal loss of anagen hairs is an anagen effluvium.

What happens in alopecia areata?

Alopecia areata usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called “exclamation point” hair). In rare cases, complete loss of scalp hair and body hair occurs. The hair loss often comes and goes-hair will grow back over several months in one area but will fall out in another area.

Alopecia areata is a common autoimmune disorder that commonly results in unpredictable hair loss. It affects 2% of Americans (roughly 6.5 million people) and can affect anyone regardless of age and gender.


Alopecia areata can cause different types of hair loss. Each of these types has a different name –

  • Alopecia areata (hair loss in patches).
  • Alopecia totalis (lose all hair on the scalp).
  • Alopecia universalis (lose all hair on the body).


Alopecia areata is considered to be one of the autoimmune disorders – lymphocytes aound the hair follicles release chemical messengers (called cytokines) that reject the hair for unknown reasons.

Alopecia areata may occur in more than one member of the family, and such families may develop other autoimmune diseases such as pernicious anaemia and vitiligo. It is also more common in patients with chromosomal disorders such as Down syndrome.

Like many other health problems, it sometimes starts after a stressful event. Alopecia areata itself may be emotionally very distressing.

Causes may include –

  • Aging
  • Genetics
  • Illness
  • Some medications, such as chemotherapy
  • Malnutrition
  • Autoimmune disorder, in the case of alopecia areata
  • Smoking


  • Male pattern hair loss – Thinning or complete loss of hair at the hairline and top of the head.
  • Female diffuse hair loss – A gradual thinning of hair, especially on the top of the head. The hairline usually stays the same.
  • Alopecia areata – Broken hairs, or hairs easily removed; one or more round or oval bald patches.


Treatment is not mandatory because the condition is benign, and spontaneous remissions and recurrences are common. Treatments used are believed to stimulate hair growth, but no evidence indicates they can influence the ultimate natural course of alopecia areata. Treatment modalities usually are considered first according to the extent of hair loss and the patient’s age.


For male pattern hair loss –

  • Minoxidil (Rogaine)
  • Finasteride (Propecia)

For female diffuse hair loss –

Minoxidil (Rogaine) – Rogaine must be used indefinitely to keep regrown hair.

For alopecia areata –

Corticosteroids – usually given by injection in the scalp each month. In severe cases, corticosteroids may be taken by mouth.

Alternative Treatment

  • Biotin and trace minerals, such as those found in blue-green algae, may promote hair growth.
  • Beta-sitosterol and saw palmetto seem to help hair growth in men with male pattern hair loss. In one study, men who took this combination had greater hair growth than men who took a placebo.
  • Aromatherapy – One study found that massaging the scalp with a combination of several essential oils, including lavender, rosemary, thyme and cedarwood, improved hair growth. Since essential oils can be toxic, they are mixed with another oil, in this case, jojoba or grapeseed oil, before putting it on the skin.
  • Therapeutic massage increases circulation (helping bring more blood to the scalp) and reduces stress. Scalp massage using essential oils of rosemary, lavender, thyme, and cedarwood may help increase circulation.

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