Tag Archive for: Alopecia totalis

Alopecia Areata: Is it Hereditary?

Genes play a major role in our appearance. For example, you may have inherited your father’s striking eye color and his sunny smile. But did you inherit his bald patches? If you’re reading this article then you’ve probably noticed a family member’s thinning hair and wondered, “Is alopecia areata hereditary?” Let’s find out. 

What is Alopecia Areata?

The term “alopecia” means hair loss. Therefore, alopecia occurs under a variety of conditions, like chemotherapy-induced alopecia and frontal fibrosing alopecia. Alopecia areata is an autoimmune condition that results in discrete bald patches throughout the scalp, face, or body. The immune system mistakenly targets hair follicles, which results in hair loss. In some cases, the entire head is affected causing complete baldness. (01)

Alopecia areata is not life-threatening, but it can negatively affect a person’s mental health. A study of individuals diagnosed with alopecia areata found high levels of anxiety (62%) and depression (38%) among participants. Therefore, hair loss conditions like alopecia areata don’t cause physical pain – but they can cause a great deal of psychological distress. (01)

What Causes Alopecia Areatea?

The body’s immune system fights against foreign invaders, protecting the body from pathogens. For the most part, the immune system does their job excellently. In some cases, however, the immune system can attack the body’s own cells. In the case of alopecia areata, the immune system strikes at the hair follicles, triggering an early start of the hair follicle’s “resting phase,” also called the telogen phase. The follicle loses its strand of hair and stops producing more strands.  The exact cause of alopecia areata is yet unknown. 

What are the Symptoms of Alopecia Areata?

Most people visualize a bald head when they hear the term alopecia areata. However, alopecia areata can affect any part of the body, like the legs or beard area. Symptoms of alopecia area include: 

  • Distinct oval or round-shaped patches on the scalp.
  • Areas of hair loss that get larger with time.
  • Two or more patches that grow larger and connect. 
  • Hair loss that affects one side of the head more than the other (asymmetrical). 
  • Fragile or white-spotted nails. 

One of the hallmarks of alopecia areata are the short broken hairs or “exclamation point” hairs located at the perimeter of bald patches. These hairs are narrower at the base and thicker at the tip. A frustrating aspect of alopecia areata is the condition’s unpredictable nature. The condition may come and go, with hair regrowth and then subsequent episodes of hair loss. Some individuals may experience a complete loss of hair on their body, though this occurrence is very rare. (01)

What are the Types of Alopecia Areata?

Alopecia areata shows up differently in each person. For example, one person may find small bald patches on one side of their head, while another person with alopecia areata may experience total hair loss. 

The three primary types of alopecia areata are: (02)

  • Patchy Alopecia Areata. Individuals with patchy alopecia areata develop one or more round bald patches on the scalp, eyebrows, armpits, or eyelashes. 
  • Alopecia Totalis. Alopecia totalis causes complete baldness, resulting in total loss of hair on the scalp. 
  • Alopecia Universalis. People with alopecia universalis experience a total loss of hair throughout their body, including the hair on their finger and toes. 

Fortunately, lost hair from alopecia areata often grows back, particularly with treatment. Even with the loss of hair, hair follicles remain “alive” and operational. Therefore, it’s possible to regrow hair, even after long periods of hair loss. People with alopecia areata may experience cycles of hair loss and regrowth throughout their lives. New hair may appear fragile and white, at first, then slowly return to their original color. (02)

Who Gets Alopecia Areata?

According to the National Alopecia Areata Foundation (NAAF), about 7 million people in the U.S. are affected by the condition. Alopecia areata also affects all racial and ethnic groups throughout the world. Any person at any age can develop alopecia areata, but the condition appears before the age of 20 in about 60% of people with the disorder. When alopecia areata develops in children under 10, however, hair loss tends to be more extensive and progressive. (03)

People with following disorders have a higher risk of developing alopecia areata: 

  • Vitiligo
  • Eczema
  • Allergies
  • Hypothyroidism
  • Down Syndrome
  • Systemic Lupus Erythematosus 
  • Ocular Cicatricial Pemphigoid 
  • Diabetes
  • Rheumatoid Arthritis

Cancer patients receiving treatment may also develop alopecia areata. For example, a cancer drug called nivolumab has been known to cause alopecia areata a few months after treatment. This form of alopecia areata is called nivolumab-induced alopecia. In this case, hair loss is thought to be a good sign that the cancer medication is doing its job well. (03)

Having a family member with alopecia areata may raise a person’s risk of developing the condition. Data indicates that approximately 10% to 20% of people with alopecia areata have a blood relative with the condition. Having said that, having a family member who is diagnosed with alopecia areata does not guarantee that you will develop the condition. (02)

Is Alopecia Areata Hereditary?

Whether alopecia areata is hereditary or not is unknown. Research into the condition has identified hair follicle specific genes, such as (peroxiredoxins) PRDX5 on chromosome 11q13. PRDXs are enzymes within hair follicles, and may be responsible for influencing autoimmune disease. Additionally, autoimmune disorders in general are thought to have genetic components, making them likely to have hereditary factors. (04)

However, the environment, lifestyle choices, and individual health may also play significant roles regarding whether an individual will develop an autoimmune condition like alopecia areata. A recent article in the journal Nature stated that autoimmune diseases occur due to a combination of variables, like genetic predisposition and environmental triggers that disturbs the immune system’s ability to decipher the body’s own tissues. (04)

It’s important to keep in mind that more than half of people who are diagnosed with alopecia areata do not have a family link to the condition. Furthermore, genetic diseases often skip generations or people in families with no predictable pattern. In short, there is no definite answer – at this time– whether autoimmune diseases like alopecia areata are hereditary. 

As with many health conditions that have a genetic component, alopecia areata’s genetic links are not the only deciding factor.

So, is alopecia areata hereditary? All the signs point to a definite “maybe.” 

Managing Alopecia Areata

Will your children develop alopecia areata? They may, but the chances are more likely that they will not. Will you develop alopecia areata if your mother has the condition? Your risk is higher than people who do not have a family member with the condition, but the chances are that you won’t develop alopecia areata. The crystal ball is murky when it comes to alopecia areata. 

That said, the true issue is managing alopecia areata if and when it appears. Hair loss can cause psychological anguish. Getting a handle on alopecia areata symptoms before they worsen helps prevent undue stress. Happy Head’s board-certified dermatologists and hair specialists are here to help. Whether hair loss is due to alopecia areata, male pattern baldness, or telogen effluvium, we can answer your questions and assist in finding the right treatment. Contact us and start regrowing your hair today.

 

Resources: 

(01) https://www.sciencedirect.com/topics/medicine-and-dentistry/alopecia-areata

(02) https://www.aad.org/public/diseases/hair-loss/types/alopecia

(03) https://www.naaf.org/alopecia-areata

(04) https://www.nature.com/articles/d41586-021-01839-6

September is Alopecia Awareness Month – 5 Facts You Need to Know

In 1986, the National Alopecia Areata Foundation (NAAF) declared September Alopecia Awareness Month.  Throughout the month, public service and fundraising campaigns will generate awareness about alopecia areata and support people who live with the condition.  If you see someone sporting a blue ribbon this month, odds are they are promoting alopecia awareness.  

As a telemedicine company dedicated to helping people regrow their hair, Happy Head is proud to support the movement.  Being diagnosed with alopecia can make people feel powerless. However, recent advances give patients more options and hope than ever before.  Here are some facts about the condition and what you can do if you or someone you know is diagnosed.  

1) 6.8 Million People in the United States Are Affected by Alopecia Areata (01)

If you have alopecia, there’s a whole community out there who can relate.  Alopecia areata is an autoimmune disease affecting about 2.1% of the American population. (02)  The percentage may seem small, but it isn’t.  

Three types of alopecia areata exist:

  1. Patchy Alopecia Areata is the most common type.  It leaves small, round spots on your scalp
  2. Alopecia Totalis is when people lose all of the hair on their scalps
  3. Alopecia Universalis occurs when people lose all of the hair on their entire bodies

Alopecia areata can occur with little to no warning in otherwise healthy people.  The condition occurs when a person’s immune system attacks the hair follicles, causing inflammation and hair loss.  Usually, the head and face are affected, but people can lose hair from any part of their bodies in small or large patches.  Neither doctors nor researchers fully understand the cause, but they believe that genetic and environmental factors are involved.  

Alopecia areata is unpredictable, which makes it especially frustrating.  Some people are only affected once, while others have recurrences.  Hair regrowth is unpredictable as well.  Some people can fully regrow their hair, while others cannot.  Treatments to help people regrow their hair are available, but unfortunately, there isn’t a cure.  

2) Alopecia Areata Has Some Common Symptoms

If you think you may be experiencing alopecia areata, you may see: 

  • Round patches about the size of a quarter on your scalp or other areas.  Keep in mind that everyone is different. The patches may be smaller or larger. 
  • Hair growing and falling out at the same time in different parts of your body
  • Substantial hair loss, quickly
  • Asymmetrical hair loss on one side of the scalp rather than on both sides
  • Hair that is narrow at the base and next to the scalp that looks like exclamation marks
  • Rows of tiny dents in your fingernails 

Keep in mind that alopecia areata presents differently in every person.   If you lose your hair, it’s difficult to determine how much you will lose or how long the episode will last.  Trying to self-diagnose alopecia areata is not recommended if your hair is thinning or balding.  Make an appointment with a board-certified dermatologist and hair specialist to get a professional evaluation and diagnosis.  

3) Other Types of Alopecia Can Cause Hair Loss Too

Many conditions can cause hair loss besides alopecia areata. Examples of common types include:

  • Telogen Effluvium causes temporary hair loss due to illness or stress.
  • Androgenetic Alopecia results when too much testosterone converts to an anagen called Dihydrotestosterone (DHT) and is the most common cause of baldness and thinning among men and women.
  • Traction Alopecia occurs when hair is pulled back too tightly into buns, braids, or ponytails.
  • Cicatricial Alopecia (scarring alopecia) occurs when scars form over the hair follicles causing existing hair to fall out and blocking the growth of new hair.

 

The best thing to do if you notice that your hair is thinning or balding is to consult with a medical professional.  He or she can evaluate your case and run any tests necessary to make a diagnosis.  In many cases, treatments such as Minoxidil and Finasteride are available to help regrow hair that has been lost.  

4) New Medications Are Showing Promise in Treating Alopecia Areata

Some people with alopecia areata experience spontaneous hair regrowth.  Others do not.  When hair does not regrow on its own, treatment is available.  

Exciting progress has been made recently in helping people with alopecia areata regrow their hair.  It has recently been discovered that a category of medications called Janus Kinase (JAK) inhibitors can effectively block the inflammatory response thought to be the cause of alopecia areata, allowing for hair growth.  Although JAK inhibitors are often prescribed off-label, one JAK inhibitor was FDA approved in June.  Olumiant (Baricitinib), a medication used to treat rheumatoid arthritis, was approved for adult patients with severe alopecia areata.  In clinical trials, the medication helped a significant number of people regrow their scalp hair to 80 percent compared to a placebo.  (03)

Other treatments often used to treat alopecia areata include:

  • Corticosteroids help calm inflammation and suppress the immune system to prevent further hair loss and allow new growth
  • Minoxidil stops hair from thinning and induces hair growth by enlarging the hair follicles
  • Topical Immunotherapy can be used to suppress the immune response
  • Phototherapy is ultraviolet light therapy sometimes used in conjunction with other treatments

Not every treatment works for every patient.  Often, patients need to try different medications to determine which works best for them.  Using multiple medications that achieve different objectives is also common.  For example, a patient may use Minodixidl with steroid injections and an oral immunosuppresant.  It’s also important to know that some patients will need to continue medications, even if their hair has regrown.  Discontinuing medication may cause a relapse.  

5) You Don’t Have to Leave Your House to Find a Support Group

Coping with alopecia areata is difficult for many people.  Stress, anxiety, and depression can easily accompany hair loss.  For many people, losing their hair is like losing part of their identity.  The grief process takes time.  In the meanwhile, a support group may help.  Thanks to social media, phones, and Zoom, you don’t even need to leave your sofa to access some services.  

The National Alopecia Areata Foundation (NAAF) offers support networks, a youth mentor program, and access to a free online community.  There are also Facebook groups, including one called Alopecia Areata, one called Alopecia Areata, Find a Cure, and another one for Parents of Children with Alopecia Areata.  The networks are a fast, easy way to connect with others who may have had similar experiences.  

Although the cause of alopecia areata is still unknown, thanks to alopecia awareness activities, determined patients, and dedicated doctors, great progress is being made in the development of treatment options.  If you have any questions about alopecia areata or any other type of hair loss condition, contact us.  Our board-certified dermatologists are happy to help point you in the right direction.  

Resources:

(01) https://www.naaf.org/alopecia-areata

(02) https://www.naaf.org/alopecia-areata

(03) https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata

Why Self-diagnosing Your Hair Loss is a Bad Idea

“When did you graduate from medical school?” my husband asks me on a regular basis.  I didn’t, but I am a self-proclaimed expert in the medical field anyway.  Why wouldn’t my Google education make me highly qualified to diagnose the whole family’s symptoms and illnesses?  Evidently, I’m not the only one self-diagnosing.  A survey conducted in March 2020  indicated that nearly one-third of all Americans do their own medical research. (01)

Being your own doctor can work against you though.  In fact, when I first started losing my hair, I didn’t even think to have it checked.  Based on what I read, postpartum hair loss is normal, and I had two babies in two years.  I would never in a million years have guessed that I had alopecia.  However, knowing what I know now, I do not recommend waiting to consult with a medical professional if you’re noticing an unusual amount of hair loss.  Treating hair loss early helps you prevent further shedding and even regrow your hair.  Here are seven more reasons why you should schedule an appointment with a board-certified dermatologist and hair specialist if you’re concerned about the amount of hair you’re losing. 

Reason #1:  Dermatologists are familiar with hair loss patterns associated with specific hair loss conditions.  

Your dermatologist has spent countless hours studying and memorizing the different types of hair loss.  Many times, just looking at patients’ hair loss patterns gives your dermatologist clues as to where to start with a work-up to get a diagnosis.  Common hair loss conditions and associated patterns are:

  • Androgenic alopecia (men) – Receding hairline and gradual thinning on top
  • Androgenic alopecia (women) – Widening of the part 
  • Alopecia areata – Patchy or circular bald spots on the head, eyebrows, or beard
  • Telogen effluvium – Overall thinning due to sudden hair loss
  • Fungal infection – Scaly patches that spread over the scalp
  • Alopecia totalis – Full-body hair loss

If your dermatologist suspects that you have androgenic alopecia, known as male or female pattern baldness, he or she may use the Norwood scale, a scale of 1 to 7, to track the progression of your hair loss.  The scale helps your dermatologist recommend the best possible treatment options to prevent further hair loss and stimulate growth based on the amount of recession or thinning you have.  

Reason #2:  Your doctor can determine the severity of your hair loss

Losing a certain amount of hair is normal and is part of the hair growth cycle.  How do you know if the amount you’re seeing in the sink or shower is too much?  You don’t.  However, once your dermatologist has an idea of your hair loss pattern, he or she has a number of tools and tests he or she can use to determine the extent of your hair loss.  The most common are:

Pull Test

A pull test is pretty much as the name indicates.  During the test, your doctor will gently tug on small sections of hair from parts of your scalp.  Usually, the litmus test is six or more strands.  If you lose that much, your hair loss is active.  

Scalp Biopsy

A scalp biopsy, also known as a punch biopsy, is often used to determine what type of alopecia you have. It allows pathologists to see inflammation and can distinguish whether the alopecia is scarring or non-scarring.  To take the biopsy, your dermatologist numbs the area and uses a pencil-sized device to remove a small amount of tissue that is sent to a lab for analysis. The incision is closed with a couple of small stitches.   

Trichometric Analysis

If your dermatologist wants to analyze your scalp and hair, he or she may do a trichometric analysis using a small handheld device with a high-definition camera.  The device magnifies images by up to 100 times so your hair, hair follicles, and scalp can be seen in great detail.  The tool shows how much hair is covering your scalp, and the diameter of each hair strand.  Dermatologists often use this camera to monitor progress after you begin treatment.  

Fungal Culture

If your dermatologist suspects that your hair loss is due to a fungus in your hair or scalp, he or she may run this test.  Fungal cultures determine if a condition called tinea capitis, scalp ringworm, is causing your hair loss.  During the test, a small sample of skin or hair is sent to a lab for incubation.   

Reason #3:  Your vitamin levels may need to be checked

Often one of the first questions dermatologists often ask new patients is whether they have recently had a routine blood test.  The reason why is because simple vitamin deficiencies can cause hair loss.  Fortunately, if this is the case, supplements will usually solve the problem quickly and easily.  The two most common vitamin deficiencies that cause hair loss are vitamin D and iron.  

Studies have shown that vitamin D has anti-inflammatory properties and affects the hair cycle. (02)  When your body has a vitamin D deficiency, regulation of the hair follicles is challenging.  Growth and shedding cycles are disrupted causing your hair to suddenly fall out.

Iron deficiency stunts the production of hemoglobin which transports oxygen to the cells in your body, including the cells that make your hair grow.  The hair follicles lack the nutrients they need to thrive.  With an iron deficiency, hair sheds and thins, giving the appearance similar to androgenic alopecia.

 

Reason #4:  Your hormones may be out of whack

 

Your dermatologist may also run blood tests to check for hormonal imbalances.  Hormone imbalances can cause hair to get dry, brittle, thin, or fall out altogether.  The only way to know if this is the case is to have your levels checked.  

Contrary to popular belief, high or low testosterone is not an indicator of hair loss.  Research has continually demonstrated that there is not a link between serum androgen levels and androgenic alopecia. (03)  Instead, male pattern baldness could be linked to an androgen sensitivity or high androgen density. 

Factors that can affect your hormone levels include:   

Menopause

Estrogen levels fall before, during, and after menopause while testosterone levels inversely increase.  During the process, the testosterone converts to dihydrotestosterone (DHT) which attacks your hair follicles, and makes your hair fall out.  

Stress

Stress is a bigger contributor to hair loss than most people realize.  When you are stressed out, your body creates cortisol which disrupts the function and regulation of your hair follicles as well as your hair growth cycle.  

Pregnancy

During pregnancy, estrogen levels rise, causing your hair to get fuller and thicker. After the baby is born, however, those levels drop rapidly, making the excess hair shed.  It can take a while for your estrogen levels and hair loss to balance out.  

Thyroid

Both hypothyroidism and hyperthyroidism have been linked to alopecia.  In a 2013 study, patients aged 21-40 with thyroid disfunction were likely to have diffuse alopecia and alopecia areata.  Patients older than 40 were more likely to have alopecia areata and androgenic alopecia. (04)  The findings confirm the importance of checking thyroid levels when there is a hair loss issue.  

Reason #5:  You could have a scalp infection 

A number of scalp infections can cause hair loss.  These infections can easily be confused with various types of alopecia, but once treated, hair typically regrows.  Examples include:

Ringworm

Ringworm is a fungal infection that forms scaly, raised, red patches.  Itching is a common complaint among patients with scalp ringworm and is typically treated with anti-fungal medications.  

Scalp Psoriasis

Psoriasis is an autoimmune condition that causes thick red patches, and sometimes scaling.  There isn’t a cure, but proper management can help prevent hair loss.

Seborrheic Dermatitis

Seborrheic dermatitis causes dandruff in adults, characterized by dry, flaky skin, and typically does not cause hair loss.  Shampoos and topical medications are often recommended. 

Lichen Planus

Lichen planus causes inflammation and can leave tiny red bumps on your scalp.  The cause is not known for certain, although autoimmune dysfunction is one of the possible causes.  Topical creams are often used to treat symptoms, but in many cases, lichen planus will disappear without treatment.  

Your dermatologist has been trained to address and treat all of these infections.

Reason #6:  Sometimes you need an outside perspective

When your dermatologist takes your medical history, he or she may be able to identify bad habits that are affecting your hair and contributing to your hair loss.  Some of these habits may include:

  • Smoking
  • Poor diet filled with processed foods
  • Stress
  • Tight buns, ponytails, braids, or other hairstyles that can pull on your hair and cause traction alopecia
  • Compulsively pulling on your hair (trichotillomania)

Reason #7:  The most effective medications are only available by prescription

Hair loss products are similar to skincare products in that very few over-the-counter (OTC) products are truly effective.  If you have a graveyard of barely or partially used tubes and containers under your bathroom sink, you get the picture.  The reality is that besides Minoxidil which is sold OTC as Rogaine in a 5 percent formula, you’re wasting your money on OTC hair loss products.  You’ll need a doctor to write a prescription.  Some of the most effective and widely used prescription hair loss medications that your doctor may prescribe are:

Minoxidil

Designed to enlarge the hair follicles and prevent miniaturization.  Used to treat a broad spectrum of hair loss conditions.  

  • Sold OTC in foam and liquid formulas
  • Available by prescription in higher dose pills and topical formulas

Finasteride

Prevents testosterone from converting to DHT, which attacks the hair follicles and causes hair loss.  Often used to treat male and female pattern hair loss.  

  • Available only by prescription
  • Reported sexual side effects such as lower libido by some users
  • Used by both men and women, but not recommended for women of childbearing age
  • Topical formula is proven to be equally as effective as the pill without the undesirable side effects since it is not systemic.  

Retinol

A derivative of Vitamin A that improves the absorption of Minoxidil, Finasteride, and other medications that stimulate hair growth.

  • Typically not used as a stand-alone hair loss solution
  • Low OTC doses not as potent as prescription doses

Spironolactone

A DHT blocker used to treat female pattern hair loss.

  • Available only by prescription
  • Safe for women who have not been through menopause

When to see a doctor

In a 2015 study conducted by the National Library of Medicine, nearly one-third of people surveyed reported avoiding the doctor, even those with major health problems. (05)  The result was later detection, reduced survival rates, and more suffering than necessary.  You won’t die if your hair falls out, but why lose your hair if you don’t have to?  If you are experiencing hair loss, be sure to seek medical treatment from a licensed dermatologist.   Early medical intervention not only prevents further hair loss but in many cases, can help you regrow your hair.  

If you have hair loss concerns and if accessibility and/or affordability is an issue, visit us at happyhead.com.  You will have the opportunity to consult with one of our board-certified dermatologists and hair specialists.  No insurance or co-pay is required.  You only pay for the product if deemed necessary and appropriate.

Resources:

(01) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084283/#:~:text=Surveys%20suggest%20that%20a%20large,self%2Ddiagnose%20using%20online%20information.

(02) https://pubmed.ncbi.nlm.nih.gov/34553483/

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746235/

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/#:~:text=People%20often%20avoid%20seeking%20medical,survey%20reported%20avoiding%20the%20doctor.&text=Even%20individuals%20with%20major%20health,12%20avoid%20seeking%20medical%20care.