Cause

 

Alopecia areata is thought to be an auto-immune disease.  This means that the body makes antibodies to some unknown  substance such as a virus or a medication which the body recognises as foreign.  These antibodies then attack the hair follicles in areas.  The hairs within the attacked area are subsequently lost.  Stress appears to play an important role in its development

 

Does alopecia areata ever recover?

 

Most individuals recover spontaneously within about 6 months, even if nothing is done about it.  However, in a small proportion, the hair loss is progressive and should be treated.

 

What treatments are available?

 

• Application of steroid creams/ ointments/ lotions

• Irritation of the scalp with Diphencyprone/ Dinitrochlorobenzene/ DNCB or dithranol

• Minoxidil solution applied to the areas of hair loss

• Injections of the scalp with corticosteroids (cortisone)

• Oral steroids (only very extensive alopecia areata)

• PUVA including Turban PUVA

• Oral Sulfasalazine

• 308nm excimer laser

• Tofacitinib

• Baricitinib

 

The 308nm excimer laser has been used successfully to treat 9 patients with AA.  treatment was administered twice weekly for a maximum of 24 sessions.

Ref:  J Am Acad Dermatol 2004;51:837-8

 

Tofacitinib is a new treatment for alopecia areata which is currently undegoing clinical trials. This medication is classified as a Janus Kinase inhibitor which interferes with communication signals from immune cells (lymphocytes). Ruxolitinib is another member of this new class of medication.

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Another JAK inhibitor, Baricitinib (Olumiant) has just become the first systemic treatment to be approved by the US FDA for alopecia aerata (13 June 2022) . 

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How long does it take to recover?

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The recovery period could take several months, even with treatment

 

Could the hair be lost again?

 

Yes, alopecia areata could be a recurrent condition.  In some it is seasonal and in others, it worsens with stress such as at exam time.

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Nail changes in Alopecia aerata

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The following nail changes may be seen in alopecia aerate:

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• diffuse fine pitting,

• onychorrhexis - longitudinal ridges

• Beau′s lines - horizontal grooves on nails 

• longitudinal ridging,

• onychodystrophy 

• trachyonychia - roughness of the nails.

• leukonychia - white patches on nails

• red lunula - red half moons

 

Dermatoscopic features of Alopecia Areata

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​Black dots, tapered hairs                                        Curly hairs, yellow dots                                   

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​Black dots                                                               Pig tail hairs

 

Treatment with 308nm excimer light

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New treatment on the horizon 

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A new experimental treatment for alopecia areata (AA), called bempikibart, shows promising results with sustained hair regrowth even after treatment ends.

Unlike JAK inhibitors, bempikibart targets the interleukin-7 alpha receptor and the thymic stromal lymphopoietin (TSLP) pathway, potentially resetting T cell activity.

In the SIGNAL-AA phase 2a study, patients who received bempikibart showed significant improvements in hair regrowth compared to a placebo, with continued benefits even after stopping the drug. The therapy was well tolerated, with no severe side effects.

Ongoing studies are exploring its long-term safety and effectiveness. If confirmed, this treatment could revolutionize AA care.

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Further Information and support:

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Alopecia Areata (National Alopecia Areata Foundation USA)

New Zealand Dermnet

Alopecia Areata:  emedicine.medscape.com

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