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Alopecia Hair Loss - Alopecia Areata (Alopecia Totalis, Alopecia Universalis) - Causes, Symptoms And Treatment

Alternate Names : Alopecia Totalis, Alopecia Universalis

Alopecia, or hair loss, usually occurs on the scalp; hair loss elsewhere on the body is less common and less conspic uous. In the non scarring form of this disorder (noncicatricial alopecia), the hair follicle can generally re grow hair. But scarring alopecia usually destroys the hair follicle, making hair loss irreversible.

Causes of alopecia hair loss(alopecia totalis, alopecia universalis)

The most common form of non scarring alopecia is male-pattern alopecia, which appears to be related to androgen levels and to aging. Genetic predisposition commonly influences the time of onset, degree of baldness, speed with which it spreads, and pattern of hair loss. Women may experience a similar disorder, called androgenetic alopecia, characterized by diffuse thinning over the top of the scalp.

Other forms of nonscarring alopecia include:

• physiologic alopecia (usually temporary): sudden hair loss in infants, loss of straight hairline in adolescents, and diffuse hair loss after childbirth
• alopecia areata (autoimmune disorder): generally reversible and self-limiting; occurs most frequently in young and middle-aged adults of both sexes; also occurs in children
• trichotillomania: compulsive pulling out of one's own hair; most common in children.

Predisposing factors of nonscarring alopecia also include radiation, many types of drug therapies and drug reactions, bacterial and fungal infections, psoriasis, seborrheic dermatitis (from scratching the affected area), and endocrine disorders, such as thyroid, parathyroid, and pituitary dysfunctions.

Scarring alopecia causes irreversible hair loss. It may result from physical or chemical trauma or chronic tension on a hair shaft, as occurs in braiding. Diseases that produce scarring alopecia include destructive skin tumors, granulomas, lupus erythematosus, scleroderma, follicular lichen planus, and severe fungal, bacterial, or viral infections, such as kerion, deep folliculitis, and herpes zoster.

Signs and symptoms of alopecia

In male-pattern alopecia, hair loss is gradual and usually affects the thinner, shorter, and less pigmented hairs of the frontal and parietal portions of the scalp. In women, hair loss is generally more diffuse; completely bald areas are uncommon but may occur.

Alopecia areata affects small patches of the scalp but may also occur as alopecia totalis, which involves the entire scalp, or as alopecia universalis, which involves the entire body. Although mild erythema may occur initially, affected areas of scalp or skin appear normal. "Exclamation point" hairs (loose hairs with dark, rough, brush like tips on narrow, less-pigmented shafts) occur at the periphery of new patches. Regrowth initially appears as fine, downy hair, which is replaced by normal hair.

In trichotillomania, patchy, incomplete areas of hair loss with many broken hairs appear on the scalp but may occur on other areas, such as the eyebrows.

Diagnosis for alopecia hair loss

Physical examination is usually sufficient to confirm alopecia. In trichotillomania, an occlusive dressing can establish a diagnosis by allowing new hair to grow, revealing that the hair is being pulled out. The diagnosis must also identify any underlying disorder.

Treatment for alopecia

Topical application of minoxidil, a peripheral vasodilator more typically used as an oral antihypertensive, has had limited success in treating male-pattern alopecia. A new hair growth supplement, folexin has been approved for use in men and can be order here. An alternate treatment is surgical redistribution of hair follicles by auto grafting.

In alopecia areata, treatment may be unnecessary because spontaneous re growth is common. Intralesional corticosteroid injections are beneficial for small patches and may produce regrowth in 4 to 6 weeks. High-potency topical steroids are less effective. Hair loss that persists for over a year has a poor prognosis for regrowth.

Treatment of other types of alopecia varies according to the underlying cause.

Expectations (prognosis)

Full recovery of hair is common. However, alopecia areata occurring at a young age, prolonged alopecia, or the presence of eczema (atopic dermatitis) often predicts a poorer outcome.

Special considerations

• Reassure a woman with female-pattern alopecia that it rarely leads to total baldness. Suggest that she try topical minoxidil or consider the use of a wig in severe cases.
• If the patient has alopecia areata, explain the disorder and give reassurance that complete regrowth is possible.

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