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Frequently Asked Questions
What is alopecia areata?Alopecia areata is a common disease that results in the loss of hair on the scalp and elsewhere. It usually starts with one or more small, round, smooth patches. It occurs in males and females of all ages, but onset most often occurs in childhood. In alopecia areata, the affected hair follicles become very small, drastically slow down production, and grow no hair visible above the surface for months or years. The scalp is the most commonly affected area, but the beard or any hair-bearing site can be affected alone or together with the scalp. Some people develop only a few bare patches that regrow hair within a year. In others, extensive patchy loss occurs, and in a few, all scalp hair is lost (referred to as alopecia totalis) or, hair is lost from the entire scalp and body (referred to as alopecia universalis). No matter how widespread the hair loss, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years. *(NAAF) Back to TopWhat is the signal that triggers the disease to start or stop?Current research suggests that something triggers the immune system to suppress the hair follicle. It isn't known what this trigger is, and whether it comes from outside the body like a virus, or from inside. Recent research indicates that some persons have genetic markers that may increase their susceptibility to develop alopecia areata. *(NAAF) Back to TopWhere can I get help ?The National Alopecia Areata Foundation was founded in 1981 when a young Californian with the disease looked for others to share and understand her problems. It has grown into the world center of alopecia areata information, research, and service. Located in San Rafael, California, the Foundation is governed by a volunteer Board of Directors and has a professional Chief Executive Officer and staff. The Foundation is represented in Washington, D.C., and the Chief Executive Officer and others have testified before Congressional Committees. *(NAAF) Back to TopIs alopecia areata hereditary ?Yes, heredity plays a role. In one out of five persons with alopecia areata, someone else in the family also has it. Those who develop alopecia areata for the first time after the age of thirty years have less likelihood that another family member will have it. Those who develop their first patch of alopecia areata before the age of thirty have a higher possibility that other family members will also have it. Alopecia areata often occurs in families whose members have had asthma, hay fever, atopic eczema, or other autoimmune diseases such as thyroid disease, early-onset diabetes, rheumatoid arthritis, lupus erythematosus, vitiligo, pernicious anemia, or Addison's disease. *(NAAF) Back to TopWho is the most commonly affected by alopecia areata ?Research into the demographics of AA suggest that 0.05%-0.1% of the population will be affected with AA at any one time (Rook 1991, Gollinck 1990, Safavi 1992). On this basis, it can be estimated there are between 30 and 60 thousand sufferers in the UK, between 112 and 224 thousand in the USA and worldwide - between 2.25 and 4.5 million! Of course, these figures are only estimates based on regional studies, and cover all forms of AA from small patches of hair loss through to alopecia universalis. The actual expression of AA in a population probably varies from region to region. Information on how AA affects different groups of people is lacking but, as an example, it is believed that AA is slightly more common in Japanese people - particularly people of Japanese decent living in Hawaii (Arnold 1952). A recent study has put the average lifetime risk of experiencing AA at 1.7%, considerably higher than most previous estimates at around 1% (Safavi 1995). There are two schools of thought as to what extent AA affects males and females. Either AA affects males and females in equal numbers or it affects a greater number of women. There have been claims that the female to male ratio is between 1:1 (Muller 1963, Safavi 1995) and 2:1 (Friedman 1985). In most other autoimmune diseases, a greater number of women are affected with ratios of up to 10:1 for Systemic Lupus Erythematosus (SLE) (Ollier 1989). This is believed to be due in part to differences in hormone levels between the two sexes. The first expression of AA is most likely to occur in people in their teenage years or early twenties (Gollinck 1990), but individual cases have been reported in children younger than two years of age or older than 70 years (Muller 1963). Between approximately 10% and 25% of patients show a family history of AA. With 10% quoted by Muller (1963), 11% by De Weert (1984), 18% by De Waard-van der Spek (1989) and 24% by Friedman (1981) - among others. The vast majority of patients with AA are in excellent health and have no associated clinical conditions but a number of diseases have been reported showing increased prevalence in conjunction with AA for a minority of people. These include Down's syndrome (Du Vivier 1975), Addison's disease (Kern 1974, Zauli 1975), thyroid disorders (Muller 1963, Cunliffe 1969) and vitiligo (Muller 1963, Cunliffe 1969, Main 1975) among other conditions. *( KERATIN ) Back to TopWhat chances have I got of spontaneous hair regrowth?This question is very difficult to answer in relation to any one individual case. We have no way of predicting the future course of alopecia areata in any one person. As was written in a recently published book "alopecia areata is only predictable in its unpredictability" (Thompson 1996). I will have to resort to statistics to give any form of reply. About 65% of people who have alopecia areata have just one or two patches of hair loss which usually enter remission after 6 months to 2 years from first diagnosis with or without treatment. However, that leaves 35% or more who have more persistent hair loss. This may cycle through expression or remission or become more extensive and persistent. Only 7% of people with alopecia areata progress to total scalp hair loss, or alopecia universalis. It has been suggested that people who first develop alopecia areata in childhood, and/or those with a history of allergies, are more likely to have persistent hair loss - at least in the USA and Europe. A recent report from India (Sharma 1996) revealed no correlation between presence of atopy and persistence of alopecia areata which suggests regional, or racial variations in alopecia areata presentation. *( KERATIN ) Back to TopWhy is the first episode of alopecia areata most likely to occur in late teens to early twenties - particularly for women?The female humoral and cell mediated immune system response is on average more active than males and in theory may account for the increased longevity of women (Grossman 1989). In general, women are far better than men in fighting off bacterial and viral infection (Janeway 1993), but a more sensitive immune system will be more likely to develop autoimmune activity. Typically, autoimmune disease is far more common in females than males (Ollier 1992). Hormones including gonadal steroids, adrenal glucocorticoids, thymic hormones and prolactin are known to influence lymphocyte activity - but the most potent hormone affecting the immune system directly and indirectly is estrogen (Grossman 1989, Schuurs 1990). Allergies are classed as hypersensitivity reactions - an inappropriate over-reaction to foreign antigens whereas autoimmune diseases are an inappropriate over-reaction to self antigens. Extensive studies into allergy susceptibility show that for women the first symptoms most often occur between the ages of 10 and 29 (Wormald 1977) and laboratory/in vitro studies have shown that estrogen can directly stimulate lymphocytes and cytokine chemical signal production (Stimson 1988, Schuurs 1990, Fox 1991). Consequently, the hormonal changes at and after puberty are believed to increase an individual's immune system sensitivity and lead to increased potential for autoimmune disease development (Grossman 1989, Schuurs 1990). It is possible similar mechanisms are at work in AA. Women with AA can sometimes go into spontaneous, temporary remission when pregnant (Sulen 1956 in Rook 1991, Muller 1963). Equally, women have reported the first onset of AA during pregnancy (Muller 1963). Presumably induction or remission is due to the associated fluctuations in hormone levels. *( KERATIN ) Back to TopWhen is ... ?[This is the answer to the question.] Back to TopWhen is ... ?[This is the answer to the question.] Back to TopWhen is ... ?[This is the answer to the question.] Back to TopCopyright © 2003 Zeplynnesque, except where noted *( ). All rights reserved.
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