How to Get Rid of the Patchy Hair Loss in Alopecia Areata?

Aug 22, 2011
Hanish Babu

Should all Cases of Alopecia Areata be Treated? - Dr.Hanish Babu, MD

Unpredictable in its course and response to treatment, getting rid of the patchy hair loss in alopecia areata is a challenge.

Hair loss in patches, especially when recurrent, can create much anxiety in the affected individuals. Treatment of alopecia areata involves patient education and selection of appropriate measures depending upon the number, extent and recurrence of patches, age of the patient and the underlying environmental trigger for the patchy loss of hair.

Treatment of Alopecia Areata: General Measures

Patients need to be educated about the harmless nature of alopecia areata. The patchy hair loss is self limiting and there is spontaneous hair growth in 80% of patients within a period of 3 months to one year or more. Affected individuals should also be informed about the chances of recurrence even after successful treatment of the bald spots.

A detailed history and physical examination has to be undertaken to find the environmental causes of the patchy hair loss in alopecia areata, before any treatment is planned.

Should All Cases of Alopecia Areata be Treated?

Given the chances of spontaneous recovery, it is not necessary to treat all cases of alopecia areata, especially those with a limited number of first instance bald patches. Recurrent patches and extensive involvement calls for active therapeutic intervention. At times, removal of the environmental trigger, for example, a caries tooth, is sufficient to stimulate regrowth of the hairs in the bald patch.

Hence a wait and watch policy is appropriate for all patients with patchy hair loss appearing for the first time.

What is the Best Treatment Available for Patchy Hair Loss in Alopecia Areata?

Treatment of alopecia areata is directed towards the inflammation surrounding the hair bulbs and the hair growth inhibiting auto antibodies produced by this inflammatory reaction. Taking care of the environmental triggers is also equally important.

The best treatment for alopecia with a limited number of patchy hair loss is intralesional injection of depot glucocorticoids, like the triamcinolone acetonide suspension. Dermatologists dilute the medication so that it does not produce any thinning of the affected skin. Preferred interval between injections is 3-4 weeks. Some patients get regrowth following a single injection of the medication.

Proper depth of injection, strength of medication and distance between points of injections etc., are to be carefully titered for best results in getting rid of the bald spots.

In recurrent alopecia areata, addition of 2% topical minoxidil to the above regimen was found to be beneficial in achieving faster regrowth of the hair in the hairless patches.

What are the Other Treatments Available for Patchy Loss of Hair?

Intralesional corticosteroid injection is not practical in extensive patchy hair loss, alopecia totalis and alopecia universalis. Oral steroids, as weekly pulse dose, topical potent steroid applications, contact sensitizers, irritants and narrow band UVB or oral psoralen plus UVA therapy are the alternatives to intralesional therapy in extensive patchy hair loss in alopecia areata. Systemic immunosuppressants like cyclosporine induce hair growth in extensive alopecia areata, but, like systemic steroids, adverse effects limit their use in this condition.

Contact sensitizers like dinitrochlorobenzene (DNCB), squaric acid dibutylester or diphencyprone are also effective in getting rid of alopecia areata; but local irritation and swelling of regional lymph nodes produce much discomfort in the patients. These are thought act through an immune competition with the auto antibodies against the hair follicles and by flushing out the auto antibodies from the bald spots.

Potent and super-potent steroids should not be used on the face and eye brows because of the potential side effects of these topical corticosteroids. They are also not as effective as the intralesional injections.

Finally, wigs are excellent options for those with alopecia totalis and alopecia universalis not responding to conventional treatment modalities.

How is Patchy Hair Loss in Children and Pregnancy Treated?

A wait and watch policy is preferred in children and pregnant women with alopecia areata, as it is a non scarring, reversible type of patchy hair loss with spontaneous recovery the norm in most patients. Children with alopecia areata are treated with topical mometasone solution once daily, with a weekly application free interval after every two weeks of application.

In pregnancy, if the patient insists on treatment, intermittent application of topical steroids may be tried as above. Explaining about the spontaneous regrowth in alopecia areata and reassurance are better options in such cases than any active intervention.

Are Any Vitamin Supplements Useful in Alopecia Areata?

There is no evidence that vitamins play any role in the regrowth of hair in alopecia areata. However, some dermatologists prescribe folic acid, cystine, arginine, vitamin B6 and zinc supplements along with the conventional therapy in the hope of producing healthier and denser hair regrowth.

Though an innocuous, self limiting disease, alopecia areata can be very unpredictable in its normal course and response to treatment. Choosing the most appropriate therapy for this type of patchy hair loss (most of the time this means no treatment) can be a little tricky. This calls for a better interaction and understanding between the patient and the dermatologist or the trichologist.

Reference

Ralf P, Elis AO, Andrew GM. Hair Growth Disorders, in Fitzpatrick’s Dermatology in General Medicine., 7th Ed, 1: 753-777, 2008
Messenger AG et al. Disorders of Hair, in Rook’s Text Book of Dermatology, 8th Ed, 4: 66.1-66.100, 2010
Klaus W, Richard AJ. Skin Signs of Hair, Nail, and Mucosal Disorders, in Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, Sixth Ed, 961-1067, 2009.

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...