Questions and Answers about Alopecia Areata or Hair Loss
This section contains general information about alopecia
areata (al-oh-PEE-shah ar-ee-AH-tah)It describes what
alopecia is, its causes, and treatment options. Information
is also provided on current research. If you have further
questions after reading this booklet, you may wish to
discuss them with your doctor.
Will laser
therapy work for my hair loss?
This is the question most often asked of us and most
likely all LLLT laser manufacturers. You may
notice that many products, particularly ones with either no
actual laser modules (LED based) or very low powered lasers
are packaged with other medical products for the treatment
of hair loss, such as Rogaine lotions. Our Aculas laser is
extremely powerful and we offer our laser only. Quality
natural shampoos and Rogaine are readily available from your
local pharmacist, we see no reason to package other products
with our lasers. Naturally you are free to combine our laser
treatment with other forms of treatment obtained separately
from your doctor or pharmacist.
Typically, patients may observe the following
results;
-
No change of condition: No stop or
slowing of hair loss, no hair regrowth observed.
-
Stabilisation of condition: Loss of
hair has substantially slowed or stopped completely. No
regrowth observed
-
Restoration of hair: Hair loss has
stopped, and existing hair appears more healthy, thicker
and fuller.
-
Regrowth of hair: Loss of hair has
stopped, existing hair appears more healthy, ticker and
fuller. New hair regrowth has been observed.
The most important factor that dictates what result you
can expect (1-4 above) is essentially how long you have been
losing your hair, plus other factors such as hereditary
conditions, genetics, general health, hormones etc.
As a rough guide our statistics have shown;
-
Hair loss over 7 years has no real benefit from LLLT
technology, if hair follicles have been dormant for this
time, they have likely been reabsorbed into the body and
must be replaced by a hair transplant, no amount of
laser energy can solve this problem
-
Hair loss between 5-7 years has a low chance of
achieving strong results.
-
Hair loss between 3-5 years has a much better chance
of achieving strong results
-
Hair loss < 3 years responds best to laser therapy.
Note: If another underlying medical condition is causing
your hair loss, then LLLT therapy may not necessarily be
appropriate. For example, thyroid or hormonal
problems may be causing hair loss that will not respond to
LLLT treatment. Other medical conditions should
first be ruled out if they are suspected to be causing your
hair loss. Typically people in good general health need not
be concerned with this possibility.
We are often asked for more "before and after" pictures.
Our policy is not to bombard clients with numerous pictures
of above average or exceptional results.
Pictures that we do use are obviously exceptional results,
which is the entire purpose of a before and after pictures.
Again, as part of setting the expectation of our client's
results of any treatment vary from person to person.
What is Alopecia Areata?
Alopecia areata is considered an autoimmune disease, in
which the immune system, which is designed to protect the
body from foreign invaders such as viruses and bacteria,
mistakenly attacks the hair follicles, the tiny cup-shaped
structures from which hairs grow. This can lead to hair loss
on the scalp and elsewhere.
In most cases, hair falls out in small, round patches
about the size of a quarter. In many cases, the disease does
not extend beyond a few bare patches. In some people, hair
loss is more extensive. Although uncommon, the disease can
progress to cause total loss of hair on the head (referred
to as alopecia areata totalis) or complete loss of hair on
the head, face, and body (alopecia areata universalis).
What causes hair loss?
In alopecia areata, immune system cells called white blood
cells attack the rapidly growing cells in the hair follicles
that make the hair. The affected hair follicles become small
and drastically slow down hair production. Fortunately, the
stem cells that continually supply the follicle with new
cells do not seem to be targeted. So the follicle always has
the potential to regrow hair.
Scientists do not know exactly why the hair follicles
undergo these changes, but they suspect that a combination
of genes may predispose some people to the disease. In those
who are genetically predisposed, some type of
trigger--perhaps a virus or something in the person's
environment--brings on the attack against the hair
follicles.
Who is most likely to have
hair loss?
Alopecia areata affects an estimated four million
Americans of both sexes and of all ages and ethnic
backgrounds. It often begins in childhood.
If you have a close family member with the disease, your
risk of developing it is slightly increased. If your family
member lost his or her first patch of hair before age 30,
the risk to other family members is greater. Overall, one in
five people with the disease have a family member who has it
as well.
Is my hair loss a symptom
of a more serious disease?
Alopecia areata is not a life-threatening disease. It does
not cause any physical pain, and people with the condition
are generally healthy otherwise. But for most people, a
disease that unpredictably affects their appearance the way
alopecia areata does is a serious matter.
The effects of alopecia areata are primarily socially and
emotionally disturbing. In alopecia universalis, however,
loss of eyelashes and eyebrows and hair in the nose and ears
can make the person more vulnerable to dust, germs, and
foreign particles entering the eyes, nose, and ears.
Alopecia areata often occurs in people whose family
members have other autoimmune diseases, such as diabetes,
rheumatoid arthritis, thyroid disease, systemic lupus
erythematosus, pernicious anaemia, or Addison's disease.
People who have alopecia areata do not usually have other
autoimmune diseases, but they do have a higher occurrence of
thyroid disease, atopic eczema, nasal allergies, and asthma.
Can I pass hair loss on to
my children?
It is possible, but not likely, for alopecia areata to be
inherited. Most children with alopecia areata do not have a
parent with the disease, and the vast majority of parents
with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which
a child has a 50-50 chance of developing the disease if one
parent has it. Scientists believe that there may be a number
of genes that predispose certain people to the disease. It
is highly unlikely that a child would inherit all of the
genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes,
alopecia areata is not a certainty. In identical twins, who
share all of the same genes, the concordance rate is only 55
percent. In other words, if one twin has the disease, there
is only a 55 percent chance that the other twin will have it
as well. This shows that other factors besides genetics are
required to trigger the disease.
To learn more about the genes and other factors involved
in alopecia areata risk, the National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS) is funding an
alopecia areata registry. The registry is an organized
network of five centres throughout the United States that
will identify and register patients with the disease and
collect data and blood samples (which contain genes). Data,
including genetic information, will be made available to
researchers studying the genetic basis and other aspects of
disease and disease risk.
Will my hair ever grow back?
There is every chance that your hair will regrow, but it
may also fall out again. No one can predict when it might
regrow or fall out. The course of the disease varies from
person to person. Some people lose just a few patches of
hair, then the hair regrows, and the condition never recurs.
Other people continue to lose and regrow hair for many
years. A few lose all the hair on their head; some lose all
the hair on their head, face, and body. Even in those who
lose all their hair, the possibility for full regrowth
remains.
In some, the initial hair regrowth is white, with a
gradual return of the original hair colour. In most, the
regrown hair is ultimately the same colour and texture as
the original hair.
What can I expect next?
The course of alopecia areata is highly unpredictable, and
the uncertainty of what will happen next is probably the
most difficult and frustrating aspect of the disease. You
may continue to lose hair, or your hair loss may stop. The
hair you have lost may or may not grow back, and you may or
may not continue to develop new bare patches.
How is hair loss treated?
While there is neither a cure for alopecia areata nor
drugs approved for its treatment, some people find that
medications approved for other purposes can help hair grow
back, at least temporarily. The following are some
treatments for alopecia areata. Keep in mind that while
these treatments may promote hair growth, none of them
prevent new patches or actually cure the underlying disease.
Consult your health care professional about the best option
for you.
-
Corticosteroids- Corticosteroids are
powerful anti-inflammatory drugs similar to a hormone
called cortisol produced in the body. Because these
drugs suppress the immune system if given orally, they
are often used in the treatment of various autoimmune
diseases, including alopecia areata. Corticosteroids may
be administered in three ways for alopecia areata:
-
Local injections- Injections of
steroids directly into hairless patches on the scalp
and sometimes the brow and beard areas are effective
in increasing hair growth in most people. It usually
takes about 4 weeks for new hair growth to become
visible. Injections deliver small amounts of
Hydrocortisone to affected areas, avoiding the more
serious side effects encountered with long-term oral
use. The main side effects of injections are
transient pain, mild swelling, and sometimes changes
in pigmentation, as well as small indentations in
the skin that go away when injections are stopped.
Because injections can be painful, they may not be
the preferred treatment for children. After 1 or 2
months, new hair growth usually becomes visible, and
the injections usually have to be repeated monthly.
The Hydrocortisone removes the confused immune cells
and allows the hair to grow. Large areas cannot be
treated, however, because the discomfort and the
amount of medicine become too great and can result
in side effects similar to those of the oral
regimen.
-
Oral corticosteroids- Corticosteroids
taken by mouth are a mainstay of treatment for many
autoimmune diseases and may be used in more
extensive alopecia areata. But because of the risk
of side effects of oral corticosteroids, such as
hypertension and cataracts, they are used only
occasionally for alopecia areata and for shorter
periods of time.
-
Topical ointments- Ointments or
creams containing steroids rubbed directly onto the
affected area are less traumatic than injections
and, therefore, are sometimes preferred for
children. However, corticosteroid ointments and
creams alone are less effective than injections;
they work best when combined with other topical
treatments, such as Minoxidil or anthralin.
-
Minoxidil (5%) (Rogaine*)--Topical
Minoxidil solution promotes hair growth in several
conditions in which the hair follicle is small and not
growing to its full potential. Minoxidil is FDA-approved
for treating male and female pattern hair loss. It may
also be useful in promoting hair growth in alopecia
areata. The solution, applied twice daily, has been
shown to promote hair growth in both adults and
children, and may be used on the scalp, brow, and beard
areas. With regular and proper use of the solution, new
hair growth appears in about 12 weeks.
-
Anthralin (Psoriatec)--Anthralin, a
synthetic tar-like substance that alters immune function
in the affected skin, is an approved treatment for
psoriasis. Anthralin is also commonly used to treat
alopecia areata. Anthralin is applied for 20 to 60
minutes ("short contact therapy") to avoid skin
irritation, which is not needed for the drug to work.
When it works, new hair growth is usually evident in 8
to 12 weeks. Anthralin is often used in combination with
other treatments, such as corticosteroid injections or
Minoxidil, for improved results.
-
Sulfasalazine--A sulpha drug,
sulfasalazine has been used as a treatment for different
autoimmune disorders, including psoriasis. It acts on
the immune system and has been used to some effect in
patients with severe alopecia areata.
-
Topical sensitizers--Topical
sensitizers are medications that, when applied to the
scalp, provoke an allergic reaction that leads to
itching, scaling, and eventually hair growth. If the
medication works, new hair growth is usually established
in 3 to 12 months. Two topical sensitizers are used in
alopecia areata: squaric acid dibutyl ester (SADBE) and
diphenylcyclopropenone (DPCP). Their safety and
consistency of formula are currently under review.
-
Oral cyclosporine--Originally
developed to keep people's immune systems from rejecting
transplanted organs, oral cyclosporine is sometimes used
to suppress the immune system response in psoriasis and
other immune-mediated skin conditions. But suppressing
the immune system can also cause problems, including an
increased risk of serious infection and possibly skin
cancer. Although oral cyclosporine may regrow hair in
alopecia areata, it does not turn the disease off. Most
doctors feel the dangers of the drug outweigh its
benefits for alopecia areata.
-
Photochemotherapy--In
photochemotherapy, a treatment used most commonly for
psoriasis, a person is given a light-sensitive drug
called a psoralen either orally or topically and then
exposed to an ultraviolet light source. This combined
treatment is called PUVA. In clinical trials,
approximately 55 percent of people achieve cosmetically
acceptable hair growth using photochemotherapy. However,
the relapse rate is high, and patients must go to a
treatment centre where the equipment is available at
least two to three times per week. Furthermore, the
treatment carries the risk of developing skin cancer.
-
Alternative therapies--When drug
treatments fail to bring sufficient hair regrowth, some
people turn to alternative therapies. Alternatives
purported to help alopecia areata include acupuncture,
aroma therapy, evening primrose oil, zinc and vitamin
supplements, and Chinese herbs. Because many alternative
therapies are not backed by clinical trials, they may or
may not be effective for regrowing hair. In fact, some
may actually make hair loss worse. Furthermore, just
because these therapies are natural does not mean that
they are safe. As with any therapy, it is best to
discuss these treatments with your doctor before you try
them.
In addition to treatments to help hair grow, there are
measures that can be taken to minimize the physical dangers
or discomforts of lost hair.
-
Sunscreens are important for the scalp, face, and all
exposed areas.
-
Eyeglasses (or sunglasses) protect the eyes from
excessive sun, and from dust and debris, when eyebrows
or eyelashes are missing.
-
Wigs, caps, or scarves protect the scalp from the sun
and keep the head warm.
-
Antibiotic ointment applied inside the nostrils helps
to protect against organisms invading the nose when
nostril hair is missing.
How will Alopecia Areata
affect my life?
This is a common question, particularly for children,
teens, and young adults who are beginning to form lifelong
goals and who may live with the effects of alopecia areata
for many years. The comforting news is that alopecia areata
is not a painful disease and does not make people feel sick
physically. It is not contagious, and people who have the
disease are generally healthy otherwise. It does not reduce
life expectancy and it should not interfere with the ability
to achieve such life goals as going to school, working,
marrying, raising a family, playing sports, and exercising.
The emotional aspects of living with hair loss, however,
can be challenging. Many people cope by learning as much as
they can about the disease; speaking with others who are
facing the same problem; and, if necessary, seeking
counselling to help build a positive self-image. To address
quality-of-life issues for alopecia areata and all other
skin diseases, the NIAMS sponsored a scientific meeting in
September 2002 on the burden of skin diseases.
How can I cope with the
effects of hair loss?
Living with hair loss can be hard, especially in a culture
that views hair as a sign of youth and good health. Even so,
most people with alopecia areata are well-adjusted,
contented people living full lives.
The key to coping is valuing yourself for who you are, not
for how much hair you have or don't have. Many people
learning to cope with alopecia areata find it helpful to
talk with other people who are dealing with the same
problems. More than four million people nationwide have this
disease at some point in their lives, so you are not alone.
If you would like to be in touch with others with the
disease, the National Alopecia Areata Foundation (NAAF) can
help through its pen pal program, message boards, annual
conference, and support groups that meet in various
locations nationwide.
Another way to cope with the disease is to minimize its
effects on your appearance. If you have total hair loss, a
wig or hairpiece can look natural and stylish. For small
patches of hair loss, a hair-coloured powder, cream, or
crayon applied to the scalp can make hair loss less obvious
by eliminating the contrast between the hair and the scalp.
Skilfully applied eyebrow pencil can mask missing eyebrows.
Children with alopecia areata may prefer to wear bandanas
or caps. There are many styles available to suit a child's
interest and mood-some even have ponytails attached.
For women, attractive scarves can hide patchy hair loss;
jewellery and clothing can distract attention from patchy
hair; and proper makeup can camouflage the effects of lost
facial hair. If you would like to learn more about
camouflaging the cosmetic aspects of alopecia areata, ask
your doctor or members of your local support group to
recommend a cosmetologist who specializes in working with
people whose appearance is affected by medical conditions.
Is research close to
finding better treatments or a cure?
While a cure is not imminent, researchers are making
headway toward a better understanding of the disease. This
increased understanding will likely lead the way to better
treatments for alopecia areata and eventually a way to
prevent or even cure it.
Alopecia research ranges from the most basic studies of
the mechanisms of hair growth and hair loss in mice to
testing medications and ways to apply medications to help
regrow hair in people. Both the National Institutes of
Health and the National Alopecia Areata Foundation support
research into the disease and its treatment. Here are some
areas of research that hold promise.
-
Developing an animal model--This is a
critical first step toward understanding the disease,
and much progress has been made. By developing a mouse
with a disease similar to human alopecia areata,
researchers hope to learn more about the mechanism of
the disease and eventually develop immune system
treatments for the disease in people.
-
Mapping genes--Scientists are
studying the possible genetic causes and mechanism of
the disease both in families that have one or more
persons with the disease and in the general population.
An understanding of the genetics of the disorder will
aid in disease prevention, early intervention, and
development of specific therapies.
-
Studying hair follicle development--By
studying how hair follicles form in mouse embryos,
researchers hope to gain a better understanding of hair
cycle biology that may lead to treatments for the
underlying disease process.
-
Targeting the immune system--Several
new agents found to be effective in treating psoriasis
may prove to be effective in alopecia areata. These
drugs work by blocking certain chemical messengers that
play a role in the immune response, or by interfering
with the activity of white blood cells (called T-cells)
that are involved in the immune system's attack on hair
follicles. New therapies for treating other autoimmune
diseases like rheumatoid arthritis and lupus may also
benefit patients with alopecia areata.
-
Finding better ways to administer drugs--One
limitation of current topical therapies is getting the
drug to the source of the problem. Scientists are
looking for a substance that penetrates the fat under
the skin to deliver medication directly to hair
follicles. In laboratory animals, topically applied
synthetic sacs called liposomes seem to fill the bill.
Studies are still needed to show whether liposomes do
the same for people.
-
Understanding cytokines--Chemical
messengers called cytokines play a role in regulating
the body's immune response, whether it is the normal
response to a foreign invader such a virus or an
abnormal response to a part of the body. Researchers
believe that by giving certain inflammation-suppressing
cytokines, they may be able to slow down or stop the
body's abnormal response to the hair follicles. Because
giving the cytokines systemically may cause adverse
effects, they believe a topical medication using
liposomes to get the agents to the root of the hair
inside the follicle may be preferable.
-
Understanding stem cell biology--Epithelial
stem cells are immature cells that are responsible for
regenerating and maintaining a variety of tissues,
including the skin and the hair follicles. Stem cells in
the follicle appear to be spared from injury in alopecia
areata, which may explain why the potential for regrowth
is always there in people with the disease. By studying
the biology of these cells, and their immediate
offspring, which seem to be targeted by the immune
system, scientists hope to gain a better understanding
of factors that trigger the disease.
Glossary of terms
Acupuncture--a traditional Chinese system
of healing in which symptoms are relieved by inserting
needles beneath the skin at selected points and then
stimulating the points by rotating the needles or exposing
them to heat or electrical current.
Addison's disease--a condition that
occurs when the adrenal glands (a pair of glands situated on
top of the kidneys) fail to secrete enough corticosteroid
hormones. Without treatment, the disease can be fatal.
Alopecia areata--an autoimmune, often
reversible disease in which loss of hair occurs in sharply
defined areas usually involving the scalp or beard, but at
times every hair on the body.
Alopecia areata totalis--a form of
alopecia areata characterized by the total loss of hair from
the scalp and face.
Alopecia areata universalis--a form of
alopecia areata in which all hair on the scalp, face, and
body is lost.
Aroma therapy--the therapeutic use of
essential oils (highly concentrated aromatic extracts
distilled from a variety of aromatic plant materials
including grasses, leaves, flowers, needles and twigs, fruit
peels, wood, and roots) to promote the health of body, mind,
and spirit.
Autoimmune disease--a disease that
results when the immune system mistakenly attacks the body's
own tissues. Rheumatoid arthritis and systemic lupus
erythematosus are autoimmune diseases ("auto" means self).
Chemotherapy--the use of strong drugs to
suppress the immune system. Though originally associated
with cancer treatment, chemotherapy is used for many
different diseases involving the immune system.
Corticosteroids--potent anti-inflammatory
hormones that are made naturally in the body or
synthetically (man-made) for use as drugs. They are also
called glucocorticoids. The most commonly prescribed drug of
this type is prednisone.
Cyclosporine--a strong drug that
suppresses the immune system. Originally developed to keep
the body's immune system from rejecting transplanted organs,
cyclosporine is being used increasingly in autoimmune
diseases, including (in rare cases) alopecia areata.
Diabetes--a disease in which the body
does not produce or properly use insulin, a hormone that is
necessary to convert sugar, starches, and other food into
energy.
Evening primrose oil--the oil of a weedy
plant containing the essential fatty acid gamma linolenic
acid (GLA), which is converted into anti-inflammatory agents
by the body. Evening primrose oil is available as a
nutritional supplement and touted as a pain and inflammation
reliever.
Hair bulb--a bulbous collection of
actively growing cells at the base of the follicle that
constantly produces a strand of hair.
Hair follicle--a small cup-shaped
structure in the skin from which hair grows. The cup is
lined with cells and connective tissue.
Immune system--a complex network of
specialized cells and organs that work together to defend
the body against attacks by "foreign" invaders such as
bacteria and viruses. In some rheumatic conditions, it
appears that the immune system does not function properly
and may even work against the body.
Liposome--a synthetic microscopic globule
made of fatty layers encapsulating drugs or other
substances. Liposomes are often used to deliver substances
to the body's cells and tissues.
Pernicious anaemia--a potentially
dangerous form of anaemia, usually caused by an autoimmune
process, which results in a deficiency of vitamin B-12.
Rheumatoid arthritis--an autoimmune
disease that targets primarily the membrane lining the
joints, leading to pain, stiffness, swelling, and joint
deformity.
Systemic lupus erythematosus--a chronic
autoimmune disease of the connective tissue that can attack
and damage the skin, joints, blood vessels, and internal
organs.
Topical sensitizers--medications that,
when applied to the scalp, provoke an allergic reaction that
leads to itching, scaling, and often hair growth. They
include squaric acid dibutyl ester and
diphenylcyclopropenone.
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