The Alopecia areata is a type of non-scarring alopecia that is characterized by bald spots on the scalp. Multi-factorial origin, most investigations consider it an autoimmune disease. The patient’s immune system attacks the hair follicles, causing an interruption of the normal hair development cycle.
It is a chronic disease that does not heal. It can be controlled and do not have a visible impact on the patient; if the appropriate treatment is taken, in most cases the hair will recover in a few months, but the patient will always be at risk of developing the disease.
In the cases of very severe alopecia areata or in those casese in which the it is not the proper treatment is not taken, it can turn to an irreversible loss of hair.
Time is the main problem that the Dermatologist by Clínica Avanzada del Pelo, CapMédica find to treat a hair diseases. The time they manage to achieve improvements are usually longer than for other dermatological diseases.
It takes months to see a clinical improvement in alopecia areata patients. The signs of improvement are at first very subtle. They are only possible to be value by the dermatologist.
We always inform patients that alopecia areata has normally no sequelae. However, in cases in which it has been active for a long time, the hair does not comes out with the same characteristics. In other cases, it never grows again.
For this reason, we consider in CapMédica that it is important to treat alopecia areata so that it does not become irreversible.
It represents between the 2 and 3.5% of all Dermatology Consultations
In CapMédica, Clinica Avanzada del Pelo, it is common to have consultations related to alopecia areata, in fact, it represents between 2 and 3.5% of all consultations in Dermatology. Therefore, we see that the life quality of people who suffer from alopecia areata is limited.
Alopecia areata has an excellent prognosis, most of the patients present forms of localized alopecia areata and respond well to medical treatment. However, when associated with other diseases such as thyroid or atomic dermatitis, alopecia areata is usually more more difficult to treat.
This type of alopecia can appear at any age, however, peaking between the ages of 20 and the 50 years of age; mainly young adults and indistinctly in men and women reaching almost 1% per 1,000 inhabitants.
Alopecia areata can cause total loss of hair and body hair and nail can also be affected
When alopecia areata appears, the affected follicles stop their hair production remarkably, these are reduced and generate very small hair on the surface of the skin, which can hardly be seen. It can cause total loss of hair and body hair, and nail can also be affected.
Alopecia areata can appear as plate, multifocal, total and universal
Alopecia areata manifests itself in several ways depending on how the hair is lost and where it is located.
Depends on how it appears, it can be:
- Focal or as single plate. Some plaques without hair follicles.
- Multiple plates.
- It affects the whole head equally. A loss of 95 to 100% of the terminal hair happens. Its origin can be related to other pathologies and can affect the nails.
- It is the most severe form as it begins with plaques that grow rapidly affecting the entire head. The most serious presence is when all body hair, including eyebrows, eyelashes and pubic hair, disappear.
Depending where it appears, it is classified:
- Its name is due to the fact that it has mesh aspect, since several coexisting alopecia plates and areas of hair between them.
- In this case the hair loss is the one corresponding to the nape of the neck, where a turban is formed on the edges of the scalp.
- Diffuse: It affects the entire scalp without the plaques. It is more difficult to diagnose and in some cases a biopsy is necessary.
- Reverse osiasis. Hair loss occurs throughout the scalp, except in the line of temporary implantation.
The most effective treatment is usually the injection of cortisone in the alopecia plate
The treatment must always be prescribed by a dermatologist and must be adequate to the severity of alopecia and to the extent to which it affects the patient psychically.
Following medical treatments may be prescribed for moderate cases:
- The most effective treatment is the injection of cortisone into the alopecia plate by means of a thin needle or a needle-free injection system.
- The effects are seen four weeks after starting treatment.
- They will be repeated every four or six weeks.
- It does not prevent the appearance of new spots.
- A side effect of injections are small elevations of the skin where the injection was given, but it is a temporary effect.
- Antraline creams are a tar-derived product used in the treatment of psoriasis.
- It is usually applied in the areas of alopecia for half an hour or an hour.
- At 12 weeks, new hair growth is usually seen.
- It may cause mild skin irritation.
- Intralesional product is use because it is less atrophrogenic than triamcilonone hexacetonide.
- It is administered with a 30G needle as several intradermal injections of 0.1 ml per dot, spaced approximately 1 cm apart.
- A concentration of 10 mg / ml with a total maximum of 2 ml, or 5 mg / ml for a total maximum of 4 ml, may be used during the same visit.
- Recurrence usually appears at 4 weeks.
- Treatments are repeated every 4 to 6 weeks.
- Medication used to treat people with high blood pressure.
- Studies have shown that the topical application of minoxidil may respond to alopecia areata.
- This product needs to be applied twice a day and its association with retinoic acid seems to increase the responses obtained.
- Not for patients with extensive alopecia.
Oral cortisone has a more extensive effect than if applied intralesionally by means of injections
For cases of extensive, total and universal alopecia areata the treatments are:
- Oral cortisone has a more intense effect than if applied intralesionally by means of injections.
- Tolerable by young people.
- This medication is used in very few patients since it is necessary to administer it for a long time and the hair usually falls again when it is suspended.
Allergic Contact Dermatitis:
- The most commonly used chemical agent is diphenhydrona. Dinitrochlorobenzene (DNCB) and the ester , digallic acid has also been used.
- More than 50% of patients treated with these substances respond to treatment with hair growth.
- Continuous treatment is required.
- They can produce acute eczema lesions with a lot of itching.
- Treatment consisting of the combination of a photosensitive medication (psoralens) and long wavelength ultraviolet light (UVA).
- It needs to be applied 2 to 5 times a week for several months.
Capillary prostheses: In cases with extensive alopecia treatment is not easy, so the use of a capillary prosthesis is highly recommended.
The Dermatology specialists at CapMédica will also look at whether the patient has hairs in the form of a sign of admiration, broken hair or sharp and short hair. In other cases, nails that appear as pickets will also be affected.
At CapMedica we work with the patient in an integral manner taking into account all aspects, not only the one related to his health, but also his most personal part, so we focus on offering the treatment and follow up what is most appropriate to his needs.