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Alopecia is a permanent or semipermanent condition in which the body’s immune system attacks hair follicles, leading to an inability to grow hair on part or all of the scalp. In some cases, it can be so severe that a person loses all hair on their body including the scalp, eyebrows, eyelashes, underarms, hair on the arms and legs and pubic hair. Alopecia can occur intermittently throughout a patient’s life, in which they lose hair periodically and regrow it after a year or two, or it can be permanent. The causes of alopecia are relatively unknown, although it can be initiated by changes in hormones, pregnancy, stress, rapid weight loss, and chemotherapy, among other things. Although the condition causes no physical harm, it can be mentally and psychologically devastating for those, especially women, who must learn to navigate in the world without a traditional marker of their identity.
Classifications of Alopecia
Since alopecia is a broad term used to describe many types of permanent and semi-permanent hair loss, there are many causes and variations of alopecia. Some have clear and obvious causes while others still remain a medical mystery.
This kind of alopecia is the most common and is often referred to as male or female pattern baldness. It usually presents as a gradual thinning of the hair beginning later in life. Around 50% of men over 50 and around 50% of women over 65 are affected by this particular form of the condition. This particular version of alopecia is determined by multiple hormonal and genetic factors including DHT (dihydrotestosterone), a hormone which can affect hair follicles by shrinking them in individuals with a genetic predisposition. In men, the hair loss pattern usually shows up as a receding hairline on the top and front of the head. In women, the pattern most often begins as a thinning on the crown of the head which can radiate outward as the condition progresses.
This class of alopecia conditions is very rare. In scarring alopecia (also known as cicatricial alopecia) hair follicles are replaced over time by scar tissue. The condition usually progresses relatively slowly over time and can be either painless or accompanied by intense burning and itching and inflammation of the scalp. Although the cause behind this form of alopecia is relatively unknown, it is thought to be related to inflammation of the hair follicle which destroys the upper part of the follicle from under the skin. Since this particular section of the hair follicle is responsible for the production of hair, the condition is permanent, although it may be slowed through dermatological intervention if caught early enough.
Telogen and Anagen Effluvium
Like many mechanisms in the body, hair follicles go through cycles or stages. The first, called the anagen phase, is the phase of active growth, which can last between 3-5 years. The hair is growing during this stage, at a rate of about ½ inch per month. At the end of the anagen phase, the catagen phase begins, which is a 10 day transitional period between growth and death. The last phase, the telogen phase, is when the hair is shed from the body. After the three phases are complete, the hair follicle will usually remain dormant for about 3 to 6 months before it begins to produce new hair again. At any point in a person’s life, all three of these phases are happening simultaneously on the head and body.
In telogen effluvium, all the hair in the shedding stage comes out more quickly than normal and more of the hair enters the telogen phase than normal. Usually, about 10% of the hair is in the final stage, but with this condition, around 30% of the hair is lost. This condition is not usually permanent and can be caused by sudden trauma, childbirth, weight loss, new medication, or grief. Usually, the hair will regrow with medication or intervention after the normal period of 3 to 6 months, although it will take some time for hair to return to its previous body and length.
In anagen effluvium, hair in the anagen or growth phase suddenly sheds from the body, cutting the cycle of growth short. This condition is usually caused by toxins being introduced to the body through radiation and chemotherapy as cancer treatments, infection, or environmental pollutants. This condition is also different from the previous one because a patient will usually lose all hair including from the arms, legs, underarms, and pubic area, along with eyelashes and eyebrows. The condition is not usually permanent and can be treated by stopping or removing the toxic cause of the hair loss. Most chemotherapy drugs cause anagen effluvium. Some chemotherapy drugs, however, such as Taxotere, can cause a permanent version of this condition, for unknown reasons.
Alopecia Areata (AA)
Alopecia Areata is a little-understood autoimmune condition in which the body’s defense system (which usually attacks bacteria, viruses, and infections) turns on itself and begins attacking its own mechanisms of growth and development, such as the hair follicle. This condition most often begins as patchy and inconsistent hair loss and can develop into either
- Areata Totalis (AT), in which all the hair on the scalp is lost, resulting in total baldness or,
- Areata Universalis (AU), in which all hair on the entire body, including the scalp, is shed.
In all of these three conditions, the hair follicle itself is not destroyed, leading to the possibility of hair regrowth. Patients with this condition may experience partial regrow or patterns of regrowth and recurrent hair loss throughout their life. The earlier a person is diagnosed with this condition, the more severe and/or permanent it tends to be. The condition does have a genetic factor, although the connection is not completely transparent. In addition, those this with form of alopecia often have a higher chance of displaying other autoimmune diseases such as lupus, eczema, arthritis, psoriasis, and thyroid disease.
Treatment for Alopecia
There is currently no cure for any of the forms of alopecia. However, many of the preceding conditions have some treatment options so that the progression of the condition is slowed or hair regrowth is encouraged. Like the condition itself, responses to these treatments are unique for every individual and sometimes treatments cannot help a patient restore natural hair growth.
The most common treatment option is the use of corticosteroids, which can be administered as injections into the area of hair loss or as a topical cream applied to the scalp. These chemicals are shown to encourage hair growth after a few months of treatments.
In addition, there are currently multiple pharmaceutical treatment options, but none are shown to provide a long term cure. Minoxidil, the active ingredient in Rogaine, can be used as a stimulus for hair regrowth. It is sold as a cream and must be applied topically every day or the baldness will recur very quickly, and it is shown to work the most effectively on slowing or stopping androgenetic alopecia. It is not a long term solution for permanent and extensive hair loss. Other topical options include Anthralin and Diphencyprone (DPCP) which both attempt to manipulate or confuse the immune system to stimulate hair growth. Finesteride, another medicinal treatment option, is only given to men due to hormonal complications in women.
Although contested, the use of phototherapy or UV light to stimulate hair growth is also supported by some members of the medical community, although its use is not FDA approved. UV light is already used as a treatment for the autoimmune skin disease, psoriasis, so its use in treating alopecia is currently being explored. Like all treatment options for this condition, responses to this treatment vary from patient to patient.
Living with Alopecia
As with all long-term conditions and diseases, people living with alopecia find different manners of coping with the hair loss. Many in-person support groups and online communities exist to give individuals with the condition a space to talk about their experience about be around those who can empathize with them. Since the condition is very visible, people with alopecia often receive unwanted attention for their condition which can cause embarrassment or a fear of meeting new people, especially in those who have not had time to adjust to having alopecia. It can also lower self-esteem and self-confidence because hair is associated in our society with beauty and youth.
Individuals who are suffering from permanent alopecia due to a toxic presence introduced into their body through chemotherapy, radiation, or environmental poisoning, may feel angry and betrayed, especially if they did not give informed consent to the treatment, knowing the possible side effects. For example, the chemotherapy drug Taxotere causes permanent alopecia in 3-15% of patients who receive it. Over 700 of the women affected have taken action against the company which concealed this side effect, Sanofi-Aventis, and more are filing suit every day to make their voices heard. To join the ongoing multidistrict litigation, contact the law office of Gilman and Begidian today.