What is alopecia areata?
Alopecia areata is a chronic inflammatory disease that affects the hair follicles, it causes hair loss and / or hair usually reversible. Alopecia areata by relapses that can be repeated in life. Alopecia areata is a disease whose origin is unknown but probably related to an abnormality of immunity to familial predisposition
Alopecia areata usually occurs by one or more well plates limited where there are no more hair, or hair. The plaques of alopecia areata are of variable size, mainly localized on the scalp. Nevertheless, the plates alopecia may occur in the beard, eyebrows, eyelashes or other hairy areas of the body. The plaques of alopecia areata extend to the periphery and can come together to form large areas of alopecia. Alopecia areata is not a scarring alopecia, ie the hair root is not affected permanently destroyed.
Wafer-level of alopecia areata, the skin is smooth, white, loose, the openings of hair are sometimes dilated. When alopecia areata is scalable, easily off the hair on the edge of the plates if it takes a little overboard. The careful consideration of the scalp can view short hair whose end is swollen (exclamation point hair alopecia or hair), we also see some black dots in pilar holes (hair cadavérisés).
The plaque of alopecia areata often heals by itself after a few months of evolution even without treatment, but relapses are frequent. Three varieties are peculiar: alopecia decalvans, ophiasiques and universal. Involvement of nail polish makes alopecia areata. Alopecia in small patches of moderate expansion often enjoy prolonged remissions, eight out of ten patients had lesions over eighteen years after their first attack. The prognosis of alopecia areata is more serious than it starts at a young age or an extended form.
Many therapeutic allow regrowth of hair sometimes lasting even during severe alopecia. These treatments are not yet able to provide a permanent cure.
A better understanding of the condition, an exchange with other patients through forums and discussion groups as well as psychological support are essential to help patients live better with this benign but difficult to accept.
What causes alopecia areata?
The exact factors causing alopecia areata are unknown. It is believed that alopecia areata is an autoimmune disorder (the body considers its own cells as foreign and eliminate them), which predominantly affects genetically predisposed subjects. There are anecdotal observations of hair loss after episodes of severe stress, but more recent studies do not reveal the psychological factor behind the outbreak of alopecia or flare, alopecia areata is not a borne illness “nervous”.
What are the subjects at risk for alopecia areata?
Alopecia areata is a condition that affects men, women and children. In France, an estimated 60 to 120 000 people are affected by alopecia areata in 2007 (incidence of 0.1 to 0.2%). Total Alopecia areata affects about one in ten patients or 6650 patients (prevalence of 10.5 / 100,000-source orphanet). The risk of developing alopecia areata during a lifetime is 1.7%. But there is a familial predisposition, members of the family of an affected suffer from alopecia after three.
What are the symptoms of alopecia areata?
Alopecia areata starts abruptly at any age but most often in children or young adults, it evolves by episodes that can be repeated in life. Alopecia areata results in hair loss and / or depilation of body hair.
Alopecia areata in a small plate is the most common form, it results in one or more plates devoid of hair. The plaques of alopecia areata have a variable size and shape, they may coalesce with each other. The diffuse alopecia is rare, it results in hair loss that affects abundant throughout the scalp. Total Alopecia areata (Alopecia decalvans total) results in complete alopecia. The universal alopecia areata has a total decalvans and depilation of all body hair. Alopecia areata affects ophiasique the edge of the scalp, it is associated with a more severe prognosis. A violation of the eyelashes, eyebrows or nails may be isolated but more often accompanies severe alopecia. Involvement of the nails results in pitting, rough and brittle nails (as passed to sandpaper) which sometimes contain white spots or can be detached. Laundering sudden the whole hair is a more rare form of alopecia areata, it would be related to an interference of pigmented hair more specific, its existence is disputed by some.
Alopecia areata is sometimes associated with other autoimmune diseases (29% of patients) such as autoimmune thyroiditis (4.7%) or vitiligo (2.1%) but rarely atopy and psoriasis.
The severity of alopecia areata is evaluated based on the capillary surface damage but also in terms of impaired quality of life of which she is responsible. Alopecia areata is causing a significant impairment of quality of life and causes significant social impact in patients who are the victims. There is often a great confusion to be an evil, a decrease of vitality, anxiety and susceptibility to depression.
Stages of severity of alopecia areata
• S0: No alopecia
• S1: Surface below 25% alopecia of the scalp,
• S2: Surface alopecia between 25% and 49% of the scalp
• S3: alopecia surface between 75% and 99% of the scalp
• S4: Alopecia complete
How to diagnose alopecia areata?
The diagnosis of alopecia areata is usually easier when the disease is manifested by recurrent bald patches that heal and recurrences after a few months or years. Similarly, forms of alopecia total or universal usually pose no diagnostic problem to the dermatologist familiar with this condition.
Careful examination with a magnifying device (or dermatoscope videomicroscope) allows the dermatologist to identify the exclamation point hair and hair cadavérisés during acute episodes of alopecia areata. Careful observation of the scalp can also view short hair whose end is broken and weathered hair (twisted) to the root of the scalp. It also highlights points of yellow evocative through magnifying glass (dermatoscope). If your dermatologist suspected diffuse alopecia areata, the achievement of Trichogramma or even a biopsy can be useful, it is sometimes necessary to determine the ability of regrowth. The dermatologist may request blood tests to look for associated autoimmune diseases.
What is the evolution of alopecia areata?
Alopecia areata is a chronic condition that often continues for several years, its evolution is unpredictable. Alopecia areata by relapses that can be repeated in life. A small patch of alopecia areata often pushes its own without any treatment in a time variable from 3 to 12 months. Hair to alopecia areata in the process of regrowth are often white, often take several months before their color does not return to normal. A recent study by Tosti et al shows that more than eight out of ten patients (83.3%) who present with mild alopecia (S1) did more damage on average 18 years after initial diagnosis and a patient three (34.4%) moderate victim of alopecia areata (S1 and S2) has no active lesion on average 18 years after initial diagnosis. It should nevertheless be tempered by these remarks because the study also shows that Antonella Tosti alopecia areata usually worsens over the years and particularly since that alopecia areata is more severe at the time of diagnosis. To summarize, the long-term prognosis is even better than alopecia areata is light at the beginning and the less good it is initially serious. The long-term prognosis is less good when the alopecia begins in childhood and when it touches the edge of the hair.
What is the treatment of alopecia areata?
Alopecia areata is not a serious disease but recurrent disease seriously affects the quality of life and self-confidence. A medical care is needed, the treatment of small plates is not always necessary because they tend to push spontaneously.
It is without doubt the best alternative for alopecia in small patches of moderate size, they often push without treatment after several months of evolution. Treatment is not useful when the patient is not hampered by his affection. Sometimes you have to temporize the treatment of alopecia areata extent of the child for whom aggressive treatments are not always desirable. It should also give better treatment when hair follicles are gone and no longer allow regrowth, this point is evaluated by the dermatologist with biopsy.
• Local corticosteroids
The dermatologist uses products often the most powerful (Class 1 topical steroids) that are applied lotion to the plates or alopecia areata and away from them. This treatment lasts several weeks and can be coupled to minoxidil. It can cause a thinning of the skin and pimples that resemble acne.
• intralesional injections of corticosteroids
It is indicated for alopecia in adults if the surface is not too important. The dermatologist performs superficial bites in the affected areas. Injections are repeated every month for about 3-6 months. This treatment can be cons-indicated in cases of hypertension, diabetes or infection. It may cause temporary thinning of the skin and development of small vessels.
It is a useful complement to the regrowth of alopecia areata, the dermatologist chooses minoxidil very often that can sometimes grow downs away from treated areas (the face) as it is used in women. It is often prescribed with topical corticosteroids and anthralin.
The anthralin is an effective product whose use is not very easy because it is an irritant and skin color. It is used at increasing concentrations for short durations (10 to 30 minutes). This treatment is often offered to children when other therapies are cons-indicated. This treatment should not be associated with PUVA.
• Immunotherapy contact diphencyprone (DCP)
It is a standard treatment whose effectiveness is proved by several studies of quality, it is reserved for severe alopecia. The diphencyprone (DCP) is a chemical that has not allergenic drug status. PTD which causes allergy sustaining a minimum allows the regrowth of hair in 60 to 80% of severe alopecia. This treatment is only available in some centers, it requires an application weekly or biweekly for several months. This treatment requires detailed information of the patient because it has side effects (eczema) and complications (skin depigmentation) have not all been evaluated by large-scale studies.
Cortisone is useful systemically in severe outbreaks of the disease because it often allows to stop the fall until other treatments take over. The prescription of “large doses” in short courses (bolus) gives good results in targeted indications. Some authors propose to combine cortisone with methotrexate.
The effectiveness of ultraviolet A coupled to a photo sensitizer is an ancient treatment that sometimes gives good results. This treatment often requires multiple sessions (30 to 50) before regrowth starts. An exhibition of the whole body seems necessary. PUVA involves the risk of skin cancer, it is indicated against the child and can not be repeated too often. The use of new light sources is promising (TL01 UVB) lamps and excimer laser.
A recent study shows very good results of the therapeutic long used in the treatment of psoriasis and other ailments. It is a powerful treatment that is recommended in severe alopecia. Methotrexate is associated with cortisone systemically in small doses. The study of Professor Joly shows a severe alopecia regrowth in two out of three but may relapse occurs long after cessation of treatment in two patients.
- Cyclosporin A
This powerful treatment has suspensive effect and side effects such as use in the long term is difficult to envisage for alopecia areata.
Treatment with proven efficacy have not been proven by studies based on sufficient evidence
Aromatherapy, cryotherapy (cold therapy) gel rubefacient, isoprinosine ®, vitamins, zinc.
Disulone ®, thymopentin, caryolysine ®, pentoxifylline, interferon.
Most patients live normally with alopecia areata, they have no need of psychological care because it does not improve the prognosis of alopecia areata and does not allow faster healing. The support of family, information and participation in support groups is still a very useful aid to understanding the disease.
The help of a psychologist or psychiatrist is essential in patients who have difficulty living with their alopecia areata where they are experiencing distress. Depression and certain mood disorders are more common in patients alopecia, they require specialized care.
Cosmetic and Camouflage
- Hair Prosthesis:> Your dermatologist can prescribe a supplement or a hairpiece (wig) pending the regrowth of hair. Specialty stores offer wigs synthetic hair (up to 600 Euros) or natural (700 euros) which are more expensive but more durable. In cases of alopecia areata total, Your Health Insurance Fund reimburses the cost of the prosthesis on the basis of a package at 125 euros. Supplement your dependents may be covered partially or wholly by a supplementary insurance as a guarantee that you subscribed. Social services in your town hall, the residential care or your health insurance office can tell you for a possible support for the remaining amount under a financial help of the health and welfare (benefits extra-legal). Some fees wigs may nevertheless remain dependent on you depending on the model chosen,Also We recommend that you go to a specialist who offers solutions supported by health insurance, indicating that their usual care for hair loss treatment. The National Cancer Institute issued a sticker to stores that respects its charter, you can get a list of stores 0810 810 821.
- Hair transplants – They are not recommended in cases of alopecia areata
- Cloning – This technique is still at an experimental stage, it does not seem suitable for treating alopecia.
Better Living with alopecia areata
Our society values a lot of hair, a symbol of youth and good health, it is very difficult to live out his alopecia areata in such a context. However, most patients adapt to their condition and live a happy and fulfilled.
Better Living alopecia requires its value to its own merits and not the abundance of her hair. Most patients like to talk to other patients who are experiencing the same situation, it helps them to accept this condition. One million French have alopecia areata at some point in their life, you’re not alone. We recommend you contact the patient associations and support groups whose addresses are listed for contact with other patients.
Minimize the impact of alopecia areata is another way to live better with. In case of total alopecia, a wig may look very natural. In case of small plates, a colored powder or mascara minimize the visibility of the plates. Pencil lines mask the lack of eyebrows.
In women, a nice little scarf mask plates while jewels draw attention away from bare areas. Makeup mask hair missing on her face. Using a makeup helps. The child often wear bandanas or caps, there are styles.
What are the prospects?
Methotrexate: we hope that larger studies confirm the encouraging results come obtained by Prof. Joly.
Biologics (etanercept, efalizumab, adalimumab): Several studies are underway but preliminary results do not appear encouraging.
308 nm excimer laser: This laser allowed for an interesting push in some isolated cases of alopecia areata sclerosis.
Are there any diseases associated with alopecia areata?
Alopecia areata is sometimes associated with other autoimmune diseases (29% of patients) such as autoimmune thyroiditis (4.7%), vitiligo (2.1%) or type 1 diabetes but also to Ulcerative colitis (1%) and celiac disease (1%). Alopecia areata is sometimes associated with atopy (atopic eczema 4.2%, allergic rhinitis 10%), more rarely, psoriasis (2.1%).
Alopecia areata can manifest itself by a sudden whitening of the hair?
Laundering sudden the whole hair is a more rare form of alopecia areata, it would be related more specifically to an interference of pigmented hair.
What is the influence of psychological factors in alopecia areata?
There are anecdotal observations of hair loss after episodes of severe stress, but more recent studies do not reveal psychological factors causing alopecia or onset of attacks. Subjects who have alopecia areata have more frequent episodes of depression than the rest of the general population but is not known whether this susceptibility is the cause or rather the consequence of alopecia areata. There is no doubt that psychological factors can influence the evolution of alopecia areata, but it is true for a lot of affection. Alopecia areata is not borne illness “nervous”.