Alopecia Areata

Alopecia areata is falling relatively quickly, the hair of various parts of our body, forming plaques or patches of alopecia, well circumscribed, usually single and round, but may be multiple and extensive, confluent or not. It can affect the scalp hair of the beard area, eyebrows, eyelashes, axilla, pubis, etc. It may even bring down the entire body hair (alopecia universalize).

This is a common reason for consulting a dermatologist, where you have to make a differential diagnosis with other diseases such as fungal infections (ringworm) or trichotillomania (hair pulling habit of continually) to avoid malpractice and, in the best, only useless.

A curious thing happens in alopecia areata is initially white hair respects people who already had white hair before the disease. However, if the disease persists, gray hair is also falling. Moreover, when the hair starts to reappear, it is initially white or lighter than normal, and then acquires its normal pigmentation.

The extent or degree of impact of alopecia areata is probably the most important prognostic factor, so that in the case of total alopecia (falling to 100% of scalp hair) or universal (100% drop of scalp and body) the possibility of complete cure is less than 10%.

Alopecia areata is associated with an increased frequency of other diseases, such as alterations in the nails (occur in up to two thirds of cases of alopecia areata), with autoimmune diseases (especially thyroid problems), atopic dermatitis (incidence is twice that in the general population) or even psychiatric or psychological disorders (such as anxiety or depression). Stress has often been cited as a cause of alopecia areata, although when controlled trials are designed, they have not always provided conclusive data. Although some studies have confirmed that stressful life events may precede episodes of alopecia areata, others have failed to demonstrate such a correlation. What seems clear is that the nervous system is closely related to our skin, and that how we react to stressful situations (in the broad sense) can influence and modulate the appearance of skin diseases, including alopecia areata. This has been demonstrated even in models of alopecia areata in mice which investigated the hypothalamic-pituitary-adrenal axis and its changes related to sustained stress.

Although there is a wide range of available treatments for alopecia areata (intralesional and topical corticosteroids, topical minoxidil, PUVA therapy, bexarotene …), since there are spontaneous remissions in 33% -50% of cases within one year from the start of injuries, other potential attitudes is to explain the patient’s illness and not perform any drug treatment. Psychotherapy and stress management methods can be useful in some cases.