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What
is Alopecia Areata?
Alopecia
areata is a localized, patchy, non scarring type of hair loss,
characterized by the presence of one or more round/oval hairless
patches. The underlying skin appears normal, unlike the tinea
infections, where there is crusting and breaking of hairs. On the
periphery , a few short hairs, which taper and loss pigment as they
approach the skin may be seen. This is virtually "exclamation
mark" hairs!
Alopecia
areata usually affects the scalp. Other hair bearing areas, especially
the beard are also affected. Microscopiccaly, an inflammatory
infiltration of lymphocytic cells is a distinct feature of alopecia
areata, which points towards an antigen-antibody(auto?) type of
reaction against the hair germinal cells.
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Age:
Any
age can be affected, common age group is 15-30.. The youngest
alopecia patient I have seen is a 2 year old girl. But I am yet to
see a patient above 60 years. Males make up 80% of my alopecia areata sufferers. In my OP practice, alopecia areata makes up about
5-6% of total cases!
Cause:
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Depending
upon the histological
findings, an autoimmune theory has been proposed. Its association
with other autoimmune diseases like vitiligo and Hashimoto's
thyroiditis gives further credence to this theory. The inflammatory
cell accumulation seen in histopathology is also a strong
corraborator.
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Direct
Pressure: See the Box below.
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Mobile
phones and alopecia areata! (See the Box below).
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Caries
Tooth: See the Box below.
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Stress:
Most patients who come with alopecia areata report a preceding
period of intense stressful events in their life. How the stress
affects some localized patches of hair loss, is however, not known.
But collaborating studies where cure has been affected after
applying stress management techniques in non responsive patients
point to a positive role of stress in the causation of alopecia
areata.
Associated
Findings:
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Nail
changes; About 10-20% of alopecia areata patients show nail
changes: Small pits on the nail plates, which are arranged in
horizontal or vertical rows. In some, a spotty loss of the whiteness
of the lunula (the semicircular area near the nail fold) is also
seen.
Associate
this with the tooth findings here, we are on the threshold of finding
the REAL cause of alopecia areata!
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Direct
Pressure and Alopecia Areata
Though not
mentioned in any text books, it is my observation that prolonged,
intermittent direct pressure of the hair bearing areas does cause
patchy loss of alopecia, which mostly recovers when the continuous
pressure source is removed.
-
I myself had
a patchy loss of hair above my umbilicus on my abdomen. I
was doing my MD in Dermatology and Venereology at that time
and I had a habit of studying while reclining on my arm
chair, with the text books resting on my tummy! Some of the
Dermatology text books of Dermatology, like the Rook's are
quite heavy, weighing around 3-4 Kgs. By second month, I
started getting alopecia areata on the abdomen.
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I have
noticed many of my patients getting alopecia areata on the
back of their scalp, after long periods of watching TV while
reclining on their cots with the head and neck pressed
against the railings. They got back their hair in a couple
of months when they stopped the habit!
-
Same observed
in many patients using heavy helmets with tight fittings
Are these
observations trying to tell us something? The direct pressure is
damaging the hair germinal cells and producing autoantibodies
against them, which further aggravates the problem. See the
other Boxes below as well!
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Mobile
Phones and Alopecia Areata
When the mobile
phone usage was just starting to pick up and the modern facilities
of hands free sets were not available, I started receiving many
patients with alopecia on their beards! The history was typical
that they were using their mobile phones for hours together. Along
with the alopecia, most of them also suffered from ear aches.
The moblie phones'
radio waves, evidently produces an inflammatory reaction in the
skin and thus cause damage to the hair germs in the matrix,
triggering the auto immune mechanism that results in patchy hair
loss.
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Alopecia
Areata Of Dental Origin
In
my dermatology practice I had been consistently getting around
5-6% cases of alopecia areata, somedays even 10% of cases are
alopecia areata! Naturally I became interested in digging deeper
to find out probable causes for the phenomenon. Stress was found
to be common amongst most patients, but so also in the
majority of other people as well. They all don't get alopecia
areata. Then why an increase in alopecia areata in selected
people?
Thorough
check up revealed a striking feature in many patients. Many
patients, especially those who were not responding to conventional
treatment and were getting recurrent attacks had one thing in
common. One or more caries tooth/teeth! Some were swarming with
bacteria with inflamed roots and gums. Some were innocuos looking,
not giving much trouble to the patient and ,subsequently, ignored.
I
searched the text books, none had mentioned about the connection.
I made a pubmed search, and, surprise! It had already been
mentioned in a couple of scientific papers!
The
connection may be in the similarities between the hair germinal
cells and teeth germinal cells and the auto-antibodies against one
may be attacking the other as well.(Read this along with the
involvement of the 3rd skin integument cousin in the group, the
nails in alopecia areata, and the picture becomes clearer).
However,
further studies at the molecular level is necessary to prove this
hypothesis. I have already started studies along with a dental
surgeon to study the correlation between caries teeth and alopecia
areata.
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Alopecia
Areata Management
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General
Advice
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Alopecia
Areata is an innocent disease, with cosmetogical issues.
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Alopecia
areata with solitary lesion less than 5 cm in diameter does not
require any treatment.
Lab
Investigations
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Treatment
Proper
-
Consult only a
dermatologist ! (I quite often come across
patients with alopecia areata coming with unfortunate
irreversible atrophy and leukoderma of the skin caused by high
concentration intralesional steroid injections by
nondermatologist doctors and pharmacists. They have changed a
normal looking skin into a scarred skin for life!)
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Find
the cause and remove it if possible (Posture, dental caries,
stress).
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Intralesional
Steroids in diluted strengths are the mainstay of management of large,
recurrent lesions
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Topical
steroids and counter irritants like DNCB are of limited value,
but may be effective in some. Same effect may be achieved with
onion, but with a risk of contact irritant dermatitis.
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In
resistant cases application of Psoralens in diluted
concentration followed by UVA or UVB exposure is useful
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Stress
Management Techniques are of value in recurrent cases.
When
to Consult a Dermatologist?
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When
lesions are larger than 5 cms and multiple
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Do
hair pulling test: If there is heavy fall of
hair in the periphery of the lesions
following gentle traction, this is a
sign of progression.
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If
there is any visible changes in the lesions
like scaling, crusting etc
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Alopecia
Areata Tips
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In most cases
hair growth occurs spontaneously without any treatment in a
few months. So wait and watch is a non expensive, safer
alternative!
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The
first hair re growth after treatment or spontaneous regrowth
will show fine and non pigmented hairs in the beginning. Do
not be worried. Normal hair will grow later.
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Do
not apply contact irritants from "helpful" home
remedy tips! This mat cause further worsening, and,
sometimes cause permanent scarring if the reaction is severe
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Look
for the causes mentioned above and eliminate them, as far as
possible.
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Useful Patient
Resources On Skin Disorders
About Your
Online Dermatologist
|
 Dr.Hanish Babu,
MD is a
non resident Indian Dermatologist &
Venereologist practicing in Ajman, UAE. He is
the author of the well known stress management
package 10 Days to Stress Free
Life and a net-entrepreneur. He is also
a certified hypnotist, stress management trainer and
personality development trainer. He is the web editor
of half a dozen web sites on the above
subjects.
Click Here to Subscribe to his
Stress Tips
Newsletter.
Click Here to Subscribe to his
Internet Marketing
Newsletter. |
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Disclaimer
Information on this site is provided for
informational purposes and is not meant to substitute
for the advice provided by your own dermatologist or
other medical professional. You should not use the
information contained herein for diagnosing or
treating a health problem or disease, or prescribing
any medication. Many skin diseases have similar
morphology and may resemble one another. But their
treatment varies. Hence, self diagnosis and treatment
are not advised. In case of doubt always be on the
safer side and consult your dermatologist. Your online
dermatologist will give you special tips to deal with
specific skin and cosmetic problems.
Information about each product is taken
from the labels of the products or from the
manufacturer's advertising material. Skin Care Tips
From Dermatologist.com or Dr.Hanish Babu are not
responsible for any statements or claims that various
manufacturers make about their products. We cannot be
held responsible for typographical errors or product
formulation changes. You should read carefully all
product packaging. If you have or suspect that you
have a medical problem, promptly contact your health
care provider. Information and statements regarding
dietary supplements have not been evaluated by the
Food and Drug Administration and are not intended to
diagnose, treat, cure, or prevent any
disease.
Copyright © 2006 Dr.Hanish Babu, MD. All
rights reserved
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