Alopecia Areata Overview

One or more patches of reversible baldness in any hair bearing area. The patches are classically circular, often with hard or abrupt borders.

The course of alopecia areata is hard to predict. It can appear suddenly – almost overnight or gradually over months. Some people don’t even notice it until it becomes quite obvious. A person may develop a single bald patch or many. Patches may join together to form large areas of baldness. A minority of cases progress to Alopecia Totalis (total loss of scalp hair) or Alopecia Universalis (total loss of all hair).

Severed hairs or stubble termed ‘exclamation’ hairs are often observed or around the borders of an alopecia patch. Sadly, this indicates the condition is active or becoming worse. Exclamation hairs are weakened by the immune response before breaking at scalp level. The hair follicle enters the telogen or resting phase shortly after or at the time.

Most people visit their GP for advice when alopecia patches are discovered. However, few GP’s have good knowledge of this condition. At best a patient can expect basic blood tests, a topical steroid lotion and referral to a dermatologist. Sadly, many will experience an unsympathetic response to their non life-threatening hair condition.

Alopecia Areata Causes

The possible causes of alopecia areata are endless. Viruses, Covid 19, Vaccines, accidents, ill health, shock, extreme stress, medications, a hard knock to the head. All can be potential triggers.

A trigger is often an event of some kind, approximately 2-3 months before the first bald patch began.

Further triggers may make the condition worse and cause more patches to form or an expansion of present ones. Most people are extremely anxious upon discovery of an alopecia patch, sometimes to the point of hysteria. Stress in particular can accelerate it, this includes the stress or hysteria of finding the alopecia patch.

Alopecia areata is thought to be an immune system fault. The immune system fails to recognise the follicle as ‘self’ and attacks. Some sufferers experience scalp soreness, tingling, burning or stinging as a result of this immune response. This causes the follicle to prematurely enter the resting phase.

The tendency for alopecia areata is more common in people who have parents or siblings who also suffered from it. Asthma, eczema and hay fever (allergic type people) sufferers are also more likely to develop it.

Regrowth After Alopecia – How Will My Hair Come Back?

Hair growth may start as quickly as the loss began, in some cases without treatment.
When hair regrowth starts it is often scanty and scattered.
New growth can be fine and translucent, white, or normal colour and texture.
A mixture of white and pigmented hair may grow simultaneously.
If hair growth resumes as normal colour, it may be slightly darker.
Regrowth is often curly, even if it were previously straight.

Medical Treatments For Alopecia Areata

The most common medical treatments for Alopecia are:

Topical steroids are prescribed to suppress the localised immune reaction. This does not prevent new patches forming but can slow down the reaction.
Oral steroids are occasionally prescribed for a short period of time but there are potential side effects.
Steroid injections may be administered just below the epidermis (top layer of skin). However, they are quite painful and only really suitable for treating small areas.

Cotswold Trichology Recommendations For Alopecia Areata Treatment

Holistic Approach:
Alopecia areata is an autoimmune condition and often responds favourably to a holistic approach this can include:

Supplements to support the immune system.
Diet and lifestyle changes.
Correction of deficiencies.
Counselling or CBT

Topical hair stimulants
I recommend both pharmaceutical and natural hair stimulants. Both have merit; stimulants such as Regaine may be more effective in moderate to severe alopecia. Natural stimulants are preferred for people with sensitive scalps, under 18s or where hair growth is present but fine.

Electrotherapy
Electrotherapy can be helpful in combination with the above. I use UVA therapy alongside electro vasodilatation (High Frequency) and recommend a treatment every 4 weeks.

Laser Therapy
Lasers at a specific wavelength are beneficial for hair growth and can stimulate hair follicles to regrow hair. Laser Therapy is safe and effective to combine with other treatments or use on its own. I particularly recommend the Theradome LH80 PRO laser helmet and have used it on many patients suffering alopecia. Ideally It should be used several times a week. Therefore it is more cost effective to purchase a helmet to use at home than to visit a clinic. It appears to promote hair growth in mild to moderate alopecia cases, rather than prevent alopecia patches forming.

Follow-up appointments

Alopecia areata is a very stressful condition and most patients suffer significant anxiety with it. A trichologist’s role is not only about treatment but physiological support during this process. I allocate half hour for follow-up appointments + electrotherapy treatment. I examine your scalp thoroughly and update you on the progress. Most alopecia areata patients feel encouraged and less anxious when their hair begins to recover. I can even show you the first signs of new hairgrowth using a micro-camera. Follow up appointments are important to ensure you are being consistent with treatment. This may change as your hair goes through different stages.

Camouflaging

There are various forms of ‘scalp makeup’ available which can help blend areas of baldness in with your remaining hair. These are cheap and can provide a helpful short term solution. I can advise which product would be most suitable, teach you how to apply it and match the correct colour.

SMP

In the event of long term camouflage being necessary, for example if you have stubborn patches that just won’t grow, or if you have long standing alopecia, Scalp Micropigmentation can provide a permanent solution. SMP is a treatment which involves tattooing of thousands of tiny dots on the scalp. This gives give the appearance of shaven hair or in longer hair can mask the pinkness of a bald patch.

Wigs and Hair Pieces

You may feel more comfortable wearing a wig or small hair piece until your hair recovers. I offer a wig fitting service and can help you choose a wig, cut it to suit you and show you how to take care of it. I am able to accept NHS (Worcester Acute NHST) vouchers towards wig costs as well. See more on our wig page.

Treatment Success Rate

The success rate is higher in people who seek treatment in the early stages of alopecia. Alopecia areata is an extremely unpredictable condition and therefore it is impossible to give a guarantee.