Alopecia areata triggered by immune response
Q: I am a healthy 23-year-old woman. I started noticing extra hairs in my brush, and then my mom found two bald spots on the back of my head. I did a telehealth appointment and they said it’s alopecia areata. What is that? Does the hair ever grow back? Will it happen again?
A: Alopecia areata is a chronic autoimmune disorder that results in hair loss, typically in rounded patches about the size of a quarter. The name is a mashup derived from Greek (alopecia, which refers to baldness) and the Latin word “area,” which means a patch or a vacant space.
According to medical historians, the condition was first described in the early 19th century by a British dermatologist. However, it wasn't until the late 1950s that the disease was linked to immune dysfunction. Most recently, researchers have begun to identify specific genes that may be involved in triggering the cascade of events that lead to this form of hair loss.
The hair loss in alopecia areata can occur anywhere on the body. In most cases, though, as happened with you, it affects the scalp. The condition arises when a glitch in immune response causes a disruption in the anagen phase of hair growth, which is when cells are rapidly dividing and creating new hair. This causes a premature shift into the telogen, or resting phase.
The result is hair loss that does not arise from damage to the follicles themselves. That means the hair loss in this condition is rarely permanent. Many people begin to see regrowth within a year. However, because this is a chronic condition that can occur in cycles, future episodes of hair loss are possible.
The causes of alopecia areata are not yet fully understood. Initial episodes may be linked to viral infections such as Epstein-Barr, hepatitis B and C and swine flu. There is evidence that infection with the coronavirus that causes COVID-19 can also be a trigger. Additional risk factors include autoimmune thyroid disease, autoimmune skin conditions such as eczema and psoriasis, and iron deficiency. Having a family history of alopecia areata also increases the risk.
Treatment focuses on modulating immune response and on regrowing hair. In crafting a course of treatment, a number of factors come into play. These include the person's age, the duration and degree of hair loss and its location.
For isolated bald spots, corticosteroids can mute immune response and encourage hair regrowth. In some cases, topical hair growth medications are used. In severe cases, in which the borders of multiple areas of hair loss cause extensive baldness, targeted immunotherapy medications may be recommended.
While your telehealth appointment was adequate for getting a diagnosis of your condition, it would be a good idea for you to be treated by a dermatologist. If possible, find one who has experience working with the condition. Breakthroughs in immunotherapy, including drugs that manage immune response and encourage hair regrowth, are arriving at a rapid pace. You are likely to receive the most benefit from a doctor who understands and stays abreast of them.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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