GeneHealth - Your precision medicine

Alopecia Areata

Disease Details

Family Health Simplified

Buy Membership

Description: Alopecia areata is an autoimmune disorder that causes hair loss in round patches on the scalp and other areas of the body.
Type: Alopecia areata is an autoimmune disorder. The exact type of genetic transmission is not fully understood, but it is believed to involve a complex interaction of multiple genes and environmental factors, displaying a polygenic inheritance pattern. There is some evidence linking it to specific genetic markers, suggesting a hereditary component, but it does not follow a simple Mendelian inheritance.
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 mildly painful. 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. 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.
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 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, anxiety, and depression.
Onset: Alopecia areata typically has a sudden onset, with hair loss that often occurs in small, round patches on the scalp. The exact trigger for this autoimmune condition is not well understood, but it can develop at any age, and onset can occur rapidly over a short period.
Prevalence: Alopecia areata is an autoimmune disorder that causes hair loss, often in small, round patches. The prevalence of alopecia areata in the general population is approximately 0.1% to 0.2%, which means it affects about 1 to 2 people per 1,000.
Epidemiology: The condition affects 0.1%–0.2% of the population, with a lifetime risk of 1%-2%, and is more common in 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 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, allergies, atopic dermatitis, and hypothyroidism.
Intractability: Alopecia areata is not considered intractable. While there is no cure, the condition is manageable and treatment options are available to help stimulate hair growth and mitigate symptoms. These treatments include corticosteroids, topical immunotherapy, and other medications. The effectiveness of these treatments can vary among individuals.
Disease Severity: Alopecia areata is an autoimmune condition that causes hair loss in round patches on the scalp and other areas of the body. Disease severity can vary widely among individuals.

- **Mild:** Hair loss in small patches, which may regrow on its own without treatment.
- **Moderate:** More extensive hair loss, potentially involving multiple areas of the scalp or body.
- **Severe:** Significant hair loss, possibly leading to complete loss of scalp hair (alopecia totalis) or entire body hair (alopecia universalis).

The severity can fluctuate over time, with periods of hair regrowth and subsequent hair loss.
Healthcare Professionals: Disease Ontology ID - DOID:986
Pathophysiology: Alopecia areata is an autoimmune condition where the immune system erroneously attacks hair follicles, leading to hair loss. The exact pathophysiology involves the disruption of the hair growth cycle. T-lymphocytes, a type of white blood cell, infiltrate the hair follicle and release inflammatory cytokines, which damages follicular cells and halts hair production. Genetic predisposition and environmental factors may contribute to the onset of this condition.
Carrier Status: Alopecia areata is not strictly inherited in a simple Mendelian fashion, so there's no defined "carrier" status like there is with certain genetic disorders. It is an autoimmune condition where genetic predisposition, along with environmental factors, contribute to its development.
Mechanism: Alopecia areata is an autoimmune condition characterized by hair loss. The mechanism involves the immune system mistakenly attacking hair follicles, leading to hair loss in patches.

Molecular mechanisms include:
1. **Immune Dysregulation**: T-cell mediated immune response is key. Cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells infiltrate the hair follicle and disrupt its normal function.
2. **Cytokine Production**: Pro-inflammatory cytokines like IFN-γ, TNF-α, and IL-15 are elevated and contribute to the autoimmune attack on hair follicles.
3. **Genetic Factors**: Genetic susceptibility plays a role, with certain HLA (human leukocyte antigen) genes being associated with increased risk.
4. **Downregulation of Immune Privilege**: Hair follicles usually enjoy an "immune-privileged" status, but in alopecia areata, this privilege is lost, exposing the follicles to immune attacks.
Treatment: The objective assessment of treatment efficacy is very difficult and spontaneous remission is unpredictable, but if the affected area is patchy, the hair may regrow spontaneously in many cases. None of the existing therapeutic options are curative or preventive. A 2020 systematic review showed greater than 50% hair regrowth in 80.9% of patients treated with 5 mg/mL triamcinolone injections. A Cochrane-style systematic review published in 2019 showed 5% topical minoxidil was more than 8x more associated with >50% hair regrowth at 6 months compared to placebo. In cases of severe hair loss, limited success has been achieved by using the corticosteroid medications clobetasol or fluocinonide as an injection 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, Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy 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. No one treatment is effective in all cases, and some individuals may show no response to any treatment.For more severe cases, studies have shown promising results with the individual use of the immunosuppressant methotrexate or adjunct use with corticosteroids.When alopecia areata is associated with celiac disease, treatment with a gluten-free diet 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 as a result of gluten withdrawal from the diet.In June 2022, the U.S. Food and Drug Administration (FDA) authorized baricitinib, a Janus kinase (JAK) inhibitor, for the treatment of severe alopecia areata.Ritlecitinib (Litfulo) was approved for medical use in the United States in June 2023.Fecal matter transplants (FMT) have been shown to reverse AA and support hair growth, with long lasting results, even going as far as growing additional hair on arms and face while grey hairs even regained colour. This supports the idea of a connection between gut microbiota having a part in hair loss.
Hair transplantation may be an alternative for patients with chronic local alopecia areata. The fact that the disease is autoimmune and progresses with relapses is one of the biggest question marks before surgery. There have been case reports in the literature since the early 2000s. However, in an article published long-term follow-up; It is reported that the hair transplanted to the eyebrow area falls out again due to the recurrence of the disease. A similar situation was not mentioned in previous studies on this subject. Perhaps the long-term follow-ups of other studies were not sufficient.
Compassionate Use Treatment: For alopecia areata, compassionate use treatment, off-label, or experimental treatments may include:

1. **JAK Inhibitors**: Drugs like tofacitinib and ruxolitinib, primarily used for rheumatoid arthritis, have shown promise in clinical trials for alopecia areata through their ability to modulate the immune system.

2. **Methotrexate**: Although primarily used for other autoimmune conditions, methotrexate has been used off-label to treat alopecia areata with some success.

3. **Cyclosporine**: This immunosuppressant, typically used in transplant patients, is another off-label treatment option being explored for alopecia areata.

4. **Platelet-Rich Plasma (PRP) Therapy**: An experimental treatment where a patient's own platelets are concentrated and injected into the scalp to promote hair growth.

5. **Contact Immunotherapy**: Uses chemicals like diphencyprone (DPCP) to create a mild allergic reaction and stimulate hair growth, albeit considered experimental.

6. **Biologics**: Drugs like dupilumab, which are used for other inflammatory conditions, are being studied for potential use in treating alopecia areata.

These treatments are on the experimental end and typically considered when conventional therapies have failed or are not suitable. Always consult with a healthcare professional before starting any new treatment.
Lifestyle Recommendations: Lifestyle recommendations for managing alopecia areata include:

1. **Nutritious Diet:** Including a balanced diet rich in vitamins and minerals, particularly those known to support hair health such as vitamins A, C, D, E, and B vitamins, iron, and zinc.

2. **Stress Management:** Stress can exacerbate alopecia areata. Techniques such as meditation, yoga, deep-breathing exercises, and counseling can help reduce stress levels.

3. **Gentle Hair Care:** Use mild, sulfate-free shampoos and avoid harsh chemical treatments, excessive heat styling, or tight hairstyles that might aggravate hair loss.

4. **Physical Activity:** Regular exercise can improve overall well-being and reduce stress. Aim for at least 30 minutes of moderate activity most days of the week.

5. **Adequate Sleep:** Ensure you get sufficient rest, as poor sleep can negatively impact your immune system and overall health.

6. **Support Network:** Join a support group or seek peer support to share experiences and coping strategies.

It’s also beneficial to consult with a healthcare provider or dermatologist for personalized advice and treatments.
Medication: For alopecia areata, medication options include corticosteroids (topical, injected, or oral), minoxidil, topical immunotherapy, and oral immunosuppressants like methotrexate and cyclosporine. Each option has different efficacy and potential side effects, and treatment choice typically depends on the severity and extent of hair loss, as well as patient-specific factors.
Repurposable Drugs: Alopecia areata is an autoimmune condition characterized by hair loss that typically occurs in patches. While there is no definitive cure, some repurposable drugs that have shown promise include:

1. **Tofacitinib**: Originally used for rheumatoid arthritis, tofacitinib is a Janus kinase (JAK) inhibitor that has shown effectiveness in promoting hair regrowth in people with alopecia areata.

2. **Ruxolitinib**: Another JAK inhibitor, ruxolitinib, used for myelofibrosis, has also demonstrated potential benefits for treating alopecia areata.

3. **Methotrexate**: Commonly used for rheumatoid arthritis and certain cancers, methotrexate is sometimes employed in combination with corticosteroids to treat severe cases of alopecia areata.

4. **Cyclosporine**: Typically used for autoimmune conditions and organ transplantation, cyclosporine has been found to possibly help in cases of alopecia areata by suppressing the immune system.

5. **Diphenylcyclopropenone (DPCP)**: Though originally developed for warts, DPCP can be used topically to stimulate an allergic reaction, which may lead to hair regrowth in alopecia areata patients.

These drugs are used off-label and should be administered under medical supervision for safety and efficacy.
Metabolites: Alopecia areata is an autoimmune disorder that results in hair loss. Research into its metabolic aspects includes studying various metabolites. Noteworthy metabolites associated with alopecia areata include amino acids, lipids, and sugars, which may exhibit altered levels in individuals with the condition. For instance, specific amino acids related to inflammation and immune response, such as glutamine and arginine, might be dysregulated. However, the exact metabolic profile can vary and is still being investigated to understand the disease better.
Nutraceuticals: Currently, there is limited scientific evidence specifically supporting the use of nutraceuticals for alopecia areata. Nutraceuticals are products derived from food sources with extra health benefits in addition to their basic nutritional value. Some potential nutraceuticals that have been speculated to support hair health include:

1. **Biotin (Vitamin B7)** - Often recommended for hair strength.
2. **Zinc** - An essential mineral that can play a role in healthy hair growth.
3. **Omega-3 Fatty Acids** - Found in fish oil, may support overall scalp health.
4. **Vitamin D** - Deficiency has been linked to hair loss, so supplementation could be beneficial.
5. **Antioxidants** - Such as vitamins C and E, which might reduce oxidative stress, potentially benefiting hair follicles.

However, more clinical trials and studies are needed to confirm the effectiveness of these nutraceuticals specifically for treating alopecia areata. Always consult with a healthcare provider before starting any new supplementation regime.
Peptides: Alopecia areata is an autoimmune disorder that causes hair loss in patches on the scalp and other areas of the body. Research into peptides has investigated their potential role in modulating immune responses and promoting hair growth. Peptides, specifically designed to target hair follicles, may help in the regeneration and repair of hair growth cycles.

Nanotechnology in alopecia areata treatment involves the use of nanoparticles to deliver drugs more effectively to the hair follicles. Nanoparticles can enhance the stability, penetration, and controlled release of therapeutic agents, potentially improving the efficacy of treatments for alopecia areata.