Alopecia areata: Diagnosis, treatment, and outcome

How do dermatologists diagnose alopecia areata?

Sometimes a dermatologist can diagnose alopecia areata by looking at the hair loss.

If the patch of hair loss is expanding, the doctor may pull out a few hairs. These hairs will be looked at under a microscope.

Sometimes the dermatologist will perform a skin biopsy to confirm that the disease is alopecia areata. To perform a skin biopsy, the dermatologist removes a small piece of skin so that it can be studied under a microscope.

Blood tests may be necessary if the dermatologist thinks the patient might have another autoimmune disease.

How do dermatologists treat alopecia areata?

There is no cure for alopecia areata. Hair often re-grows on its own. Treatment can help the hair re-grow more quickly. A dermatologist may prescribe one or more of the following to help the hair re-grow more quickly:

  • Corticosteroids: This medicine suppresses the immune system. It can be given as shots, with the dermatologist injecting the medicine into the places with hair loss. Sometimes a patient gets a topical (applied to the skin) form of this medicine. It may be a cream, lotion, or ointment. The patient applies the medicine to the bare spots. Less often, patients take corticosteroid pills.

    For adults with alopecia areata, these shots are often the first treatment tried. Patients receive shots every 3 to 6 weeks. Hair growth begins about 4 weeks after the last shot. Sometimes, it takes longer.

    Topical corticosteroids are less effective than shots. This is often the best treatment for children.

    Corticosteroid pills can have serious side effects. Dermatologists do not routinely prescribe them for this reason. Pills may be a treatment choice for patients with many bald spots.

  • Minoxidil: A hair re-growth medicine, minoxidil 5%, may help some patients re-grow their hair. Both children and adults can use it. Patients apply it twice a day to the scalp, brows, or beard. New hair may start to grow in about 3 months. Patients most often use this medicine with another treatment.

  • Anthralin: This medicine alters the skin’s immune function. The patient applies a tar-like substance to the skin and leaves it on for 20 to 60 minutes. A dermatologist may call this short-contact therapy. After 20 to 60 minutes, the anthralin is washed off to avoid the skin from becoming irritated.

  • Diphencyprone (DPCP): This medicine is applied to the bald skin. It causes a small allergic reaction. When the reaction occurs, a patient has redness, swelling, and itching. Dermatologists believe this allergic reaction tricks the immune system, causing it to send white blood cells to the surface of the scalp. This fights the inflammation. It also prevents the hair follicles from going to sleep, and causing the hair loss.

    With DPCP, it can take 3 months for the hair to start re-growing.

  • Other treatments: Patients often get more than 1 treatment at a time. A mix of 2 or more treatments often boosts success.

Ask your dermatologist about possible side effects (health problems that can result from the medicines). If you have a bad reaction to a medicine, call your dermatologist right away.

Researchers are working to advance the treatment of alopecia areata. They are exploring other medicines that work on the patient’s immune system. They also are looking at lasers and other light-based therapies.

Outcome

When a person has alopecia areata, the hair will start to re-grow when the body gets the right signals. Sometimes this happens without treatment. Even with treatment, new hair loss can occur. Everything depends on how the immune system reacts.

The following explains what can happen.

  • Re-growing hair: It is likely that the hair will grow back even without treatment. It may fall out again, though. Most patients lose their hair more than once before the disease goes away for good. Even people who lose all the hair on their scalp and body can have their hair grow back. When hair loss is widespread (lots of hair loss on the scalp and/or body), there is a greater chance that the hair will not re-grow.

    When hair re-grows, it can be white or fine at first. A person’s own hair color and texture often return later.

  • How long it lasts: This varies. For some people, the disease never returns. Others lose and re-grow hair for many years. No one can predict when the hair might re-grow or fall out again. This lack of control makes the disease frustrating.

  • Emotional toll: The emotional aspects of living with hair loss can be hard. Our world regards hair as a sign of youth and good health. The good news is that alopecia areata does not affect overall health. It should not stop you from achieving your goals and dreams. You should not let it stop you from doing well in school, sports, and work.

    If your hair loss bothers you a lot, you may wish to join a support group.

Learn more about alopecia areata:

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