Q1: What is Alopecia?
Alopecia is a generic term for any type of hair loss, including male pattern baldness, but it is commonly used to specifically refer to the Universalis, Totalis and Areata forms of the condition where the immune system attacks hair follicles.
Q2: What is the difference between these three types of Alopecia?
The main difference between these three types of Alopecia is the amount and pattern of the hairloss, (although there are numerous other types of Alopecia that can affect someone). Alopecia Areata is a patchy hairloss, mostly from the head and usually in circular patches. Alopecia Totalis refers to total loss of scalp hair, and may appear initially as Areata before progressing to total hairloss. Alopecia Universalis refers to total loss of hair, including all scalp and body hair.
People can progress through these different stages quickly over just a few days, or slowly over several years, and not everyone will progress to Universalis either.
Q3: What causes it?
Alopecia is a disease of the autoimmune system where the immune system becomes overstimulated and attacks healthy cells. The causes are still a bit of a scientific mystery, however more work has been done to solve alopecia in the last few years than ever before. Research shows that this process does not just affect hair follicles, but also attacks cells in the skin and nails too.
Q4: What happens to the hair? Is it dead?
The body attacks its own hair follicles by mistake thinking they are a foreign body; despite attacking the follicles, they don't die, the hair simply stops growing. Hair growth goes through several phases including the Anagen (growing phase) and a stage called the Telogen phase where the follicle rests before growing again. Each hair enters the various phases at a different stage and because the head has so many hairs on it, despite many being in the Telogen phase the individual will still have a full head of hair. With alopecia, all the hair follicles enter and remain in the Telogen semi-permanently or permanently, waiting for the signal to start growing again which doesn't come. Over time, the likelihood of the hair regrowing is diminished, but in the right circumstances it is always possible that the hair will start growing again.
Q5: What can be done to prevent it happening?
Unfortunately, not enough is known about alopecia, so nothing can prevent alopecia from happening. Hopefully in the future this will become a fully preventable and treatable disease, however for now you only know about it when you've got it.
Q6: Is there anything that can be done to treat it?
Some treatments are available, all with varying degrees of success. The effect of the treatment will vary from person to person, meaning some will be effective and sometimes they simply won’t work, at the same time leaving you with uncomfortable or difficult side effects. If you do start suffering from alopecia, the best thing to do is ask your Doctor for a referral to a dermatologist, or opt to visit a Trichologist if you would prefer. Some of the treatments available include:
- Scalp irritants - strange as this may sound, irritants like DCP or Dithranol are painted onto the scalp creating a burning sensation and redness. The logic is that through either an irritant or allergic reaction, they will provide a 'distraction' for the immune system, hopefully improving the long-term balance of the body, and enabling the hair to regrow. The expected side-effect is raw, irritated skin that can be quite painful, but which will heal; the physical response of the body is usually mixed, and whilst it can be really effective for some, and totally non-effective for others.
- Corticosteroids - either applied topically as a cream, or injected direct into the scalp, corticosteroids can help suppress the immuno-effects, enabling the hair to regrow. For some people, a single course of treatment will be enough for permanent regrowth, whereas in others the effects will be temporary or even non-existent. Short-term used, particularly when topically applied will have limited side-effects, but if taken orally or used over long periods, side-effects can become more pronounced. It's worth noting that the scalp injections can be pretty sore too!
- Minoxodil - Minoxodil is a topical scalp treatment; it is a synthetic drug used in the treatment of hairloss, and is most effective for patchy hairloss. It helps to suppress the immuno-effects, enabling the hair to regrow and fill back in. It is not normally effective for long-term use or for widespread hairloss, and can cause skin irritation.
- High-dose zinc - zinc is required for healthy growth of the skin, hair and nails and in some cases, has proved effective for alopecia patients. It is however required in very high doses and side effects include vomiting and diarrhoea.
- Immuno-suppressant drugs - used to 'switch off' the immune system, providing time for the hair to regrow, immuno-suppressant drugs are almost universally effective; BUT before you get over-excited, use can only be short-term due to the increased risk of contracting infections, and the negative effects on organs such as the liver. This means that although in many cases the drugs will be effective whilst you are taking them, many will lose their hair again when the treatment is stopped.
- Light treatments - including UVB exposure which has been effective in a few limited cases, but which is more likely to simply increase the potential for skin cancer, and exposure to UVA light when combined with oral light-sensitive drugs. The idea is that the skin will be partially damaged and the body will focus on skin repair rather than attacking itself.
As well as pharmaceutical solutions which have varying degrees of effectiveness, some people have had success with changes in diet or addition of specific minerals or vitamins if they are found lacking. Realistically however, it is entirely possible that your alopecia will be untreatable and that's why support from organisations like Alopecia UK may be a viable, more long-term solution.
The above list is by no means a definitive list of treatments, but is an overview of some of the most common ones you could be offered. More information can be found on the Alopecia UK website here,
Q7: How long will alopecia last?
The time someone will have alopecia will vary from person to person and in some will be weeks or months, whereas in others it will be permanent. Generally the rule of thumb for hairloss is that "the quicker the hair grows back the better the long term stability of the hair is"; the important thing to remember though is that the follicle is not dead and hair could start to regrow at any moment if something in the body’s immune system flicks the relevant switch on!
Q8: What does the latest research into the condition show?
There has been a lot of different types of research going on, but most recently, the focus has been on JAK inhibitors in a new study by Dr Angela Christiano. JAK inhibitors are already being successfully used for other conditions, and recently reversed hairloss in people with alopecia areata. There were only three participants in the study, but all of them saw their hair grow back after five months of treatment. This theory is now being put to the test on a larger scale in partnership with the Department of Dermatology at Columbia University Medical Centre with a clinical trial in humans.
Q9: Can Trichology help with alopecia?
Given the unpredictable nature of alopecia and the limited effect of treatments, it is difficult for many professionals to help and support with the condition. Trichologists can help with the early diagnosis of alopecia, identifying the condition, monitoring its progression, at the same time providing reassurance and passing on information about support groups and social networks for alopecia. Some topical treatments (irritant sensitisers) are also available from trichologists.
Q10: Is there anything else about alopecia that our readers might find interesting?
Yes. All of the world's leading scientists are meeting in Miami USA from November 18th –21st to share the latest research on Alopecia and hairloss. I am one of the delegates attending the ninth World Congress for Hair Research and will be reporting for Pretty Bald as one of only a few British delegates attending.
One final piece of advice, the most important thing is to ask yourself what your ultimate objective is and whether the treatment is really worth it? This is a very personal question, but alopecia sufferers should take care to be true to themselves and to ensure they focus on realistic outcomes rather than risk compromising their health through long-term treatments that aren't working.
Thanks very much Mark! We'll put you through your paces with another interview again soon!
In the meantime, anyone interested in talking to Mark, he can be reached through his website, or you can follow him on Twitter @Mark_Blake.
www.prettybald.co.uk Twitter: @PrettyBald