Dr. Suraj is a Specialist in Clinical & Cosmetic Dermatology at the Royale Hayat Hospital. Dr. Suraj treats disorders of skin, hair, and nails, while also specializing in Aesthetic Dermatology; this includes botox, fillers, and different types of lasers. 

A common auto-immune disorder, alopecia areata holds enough clout to cause immense psychological stress and discomfort amongst those suffering from it. We decided to shed some light on this particular subject, in conversation with Dr. Suraj, and address the issue head-on. Read through…

What is Alopecia Areata?

Alopecia areata (AA) locally known as “talaba” is a common, inflammatory, non-scarring type of hair loss. There are many variations in the clinical presentation, ranging from small patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA are seen in all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease and significantly affect the quality of life.

The cause of AA remains elusive though significant advancement has been made in the understanding of its causative pathophysiologic mechanisms, and it is believed to result at least in part from complex autoimmune-mediated hair follicle destruction. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities.

Are there many types of Alopecia Areata?

Several subtypes of alopecia areata have distinct presentations. Some of them have multiple patches of hair loss, some only on the back of the scalp (oophiasic type), some sudden graying type, and some total loss of hair on the scalp, eyebrows, eyelashes – alopecia totalis (AT), and some of them progress to hair loss of entire body areas – alopecia universalis (AU).

What are the outcomes after treatment?

Factors that may contribute to improvement include AA subtype, the extent of hair loss, duration of hair loss, age at onset, and family history. Approximately 5% of cases of patchy AA will progress to AT or AU. Extensive involvement indicates an unfavorable prognosis.

The oophiasis subtype can have a poorer outcome and may be less responsive to treatment, while the acute diffuse and total alopecia subtype generally has a favorable prognosis.

Are there any other diseases or factors causing or associated with AA?

Increased risk of AA development is seen in patients with atopy, including atopic dermatitis, asthma, and allergic rhinitis has been reported. Multiple autoimmune diseases (including thyroid disease, psoriasis, and vitiligo) have been shown to have a high association with AA and also possibly with rheumatoid arthritis, celiac disease, and type 1 diabetes. There are recent studies although not currently substantiated in AA, the circulating chemical mediators, the inflammatory cytokines certainly have the potential to adversely affect other organs, as seen in other autoimmune diseases like psoriasis, systemic lupus erythematosus, and rheumatoid arthritis.

Nutritional deficiencies including vitamin D and iron deficiency, are also more common in AA patients. Patients with AA have been found to have higher rates of sensorineural hearing loss.

There is a strong genetic component in AA with a 10-fold increased risk in first-degree relatives. Stress and psychological disorders are among the most commonly cited causes of AA by patients, but the exact association is still debatable. A recent study reported a high prevalence of anxiety, depression and sleep problems among patients with AA. Furthermore, reports of suicide in children and adults with AA are concerning. Food with high dietary soy oil content seems to increase resistance to AA in laboratory studies.

What are the treatment options in Alopecia Areata?

Many therapies are available for the treatment of AA, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes, and there are no currently available treatments that induce and sustain remission. 

Intralesional corticosteroids are considered a first-line treatment method for limited disease. Topical corticosteroids may be used alone or in conjunction with other treatments, including intralesional corticosteroids. Minoxidil 5% foam or solution may be used as adjuvant therapy in AA. Alone, minoxidil may be insufficient to promote complete hair regrowth. Topical immunotherapy is another option with good improvement in many.

Short courses of oral corticosteroids are often sufficient to stimulate hair regrowth; however, the side effect profile precludes long-term use, and the likelihood of relapse is significant.

Most recently, a novel therapeutic option using a group of medications called JAK inhibitors shows promising results raising the hopes of AA patients and the treating doctors more than ever before and is presently available in Kuwait. Also, many existing medications used for other indications are being evaluated for their utility in AA. 

Overall, the treatment options for alopecia areata are increasing, and there are new promising treatments on the horizon.