Managing Sudden Hair Loss

Learning Opportunities: Understanding Alopecia Areata

What is Alopecia Areata?
Alopecia Areata is an autoimmune condition targeting hair follicles, leading to non-scarring hair loss. While it often affects the scalp, any hair-bearing surface can be involved.

Who’s Most Affected?

• Age: Over 65% of cases occur before age 30, most commonly in children and young adults.

• Associations: Conditions like Hashimoto's thyroiditis, anemia, and Down syndrome often accompany Alopecia Areata. Testing for thyroid antibodies is recommended.

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Spot the Signs:

The hallmark sign? Sudden, round, smooth patches of hair loss. The skin appears normal, without scarring. Sometimes, nail pitting or ridging can accompany hair loss.

Patterns to Recognize:

Alopecia presents in various forms:

• Single or multiple patches: Sudden, discrete hair loss in well-defined areas.

• Ophiasis: Band-like hair loss along the scalp margins.

• Alopecia Totalis: Complete loss of scalp hair.

• Alopecia Universalis: Total body hair loss (affecting ~1% of patients).

Hair may regrow after several months, but recurrence in other areas is common. 

Diagnosis Tips:

• Clinical Exam: Usually sufficient, but in confusing cases, a scalp biopsy can help confirm the diagnosis.

• Hair Pull Test: Gently pulling hair near the affected area can reveal active hair shedding.

• Lab Tests: Check for thyroid disease, and other associated autoimmune conditions.

Prognosis:

• Patients with single or few patches often have a favorable outlook with spontaneous regrowth.

• Those with Alopecia Totalis or Universalis have a less predictable prognosis.

• Adverse factors include early onset (<1 year old), atopic dermatitis, and vitiligo.

 Treatment Options
Responses to treatment can vary widely, and managing expectations is crucial.

• Topical Treatments:

  • Topical Steroids: First-line for scalp involvement, especially potent fluorinated steroids.

  • Minoxidil 5%: Can show regrowth as early as 12 weeks.

  • Contact Immunotherapy: Using agents like squaric acid.

• Intralesional Treatments:

  • Kenalog Injections: Administered at 3 mg/cc, spaced 1 cm apart, every 4–6 weeks. Careful not to over-inject to avoid atrophy.

• Systemic Treatments:

  • Oral Steroids: May be justified in cases of rapid hair loss to slow progression, but chronic use is discouraged due to side effects and risk of relapse after discontinuation.

  • Other Systemic Agents: Dermatologists may consider methotrexate, cyclosporine, or biologics in certain cases.

Treatment by Area:

• Eyebrows & Eyelashes: Treated with topical steroids or products that enhance eyelash growth.

• Facial Hair: Similar topical treatments as the scalp

Here’s something to keep in mind, DERM Community: there’s no one-size-fits-all approach to managing this disease. Each patient’s condition and needs must be carefully evaluated. 

Want to learn more about tailoring treatments? Explore our Hair & Nails course, where we take an in-depth look at Alopecia Areata and showcase fascinating clinical cases you won’t want to miss

Emotional Support Matters
Young children, especially girls, can be particularly affected by visible hair loss. It’s essential to reassure both patients and parents that they are healthy and whole, despite cosmetic changes. Support groups like the Alopecia Foundation can provide crucial resources for patients and families alike.

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