Alopecia areata represents one of the most common types of non scarring alopecia. It is estimated that it affects 1% of the population in its strongest forms and 2-8% in its lighter forms. It usually starts with the formation of a single spot or multiple spots with no hair with a circular or oval shape, different dimensions and clear margins. Despite this hair loss is usually asymptomatic with some patients reporting a burning sensation, itching and paraesthesia before the spot appears. The skin sometimes looks erythematous and oedematous.
Around the hairless spot it is possible to notice:
- hair with the typical “exclamation point” appearance
- dead-looking hair
The pathology can go into remission and then can re-emerge and worsen. In about 10-13% of patients the disease evolves into stronger and more widespread forms. It can affect people of any age but the highest percentage occurs before puberty and among people aged 20-40.
Alopecia areata is an autoimmune disease. A fundamental role in its outbreak is played by activated CD8 lymphocytes, due to their cytotoxic action towards the hair follicle.
The remission rate reaches 50% at 5 years old, 80% at 10 and 100% at 20. Remissions are often worse than the initial episode.
Alopecia areata is characterized by remission and regrowth phases. These phases can hardly be predicted. The psychological impact of the disease is high as the individual lives with a condition of insecurity and discomfort. Women lose their femininity and identity.
To date there isn’t any effective therapy to treat this autoimmune pathology once and for all.
Therapies include local corticosteroids and sensitizing and immunostimulant therapies.
Recent scientific publications showed a positive response of regenerative therapies, such as PRP and stem cells.
TELOGEN EFFLUVIUM (or STRESS-INDUCED ALOPECIA) is a common hair loss condition. It is characterized by an increase of hair loss in the telogen phase of the hair growth cycle.
It is usually caused by psychotic or physical conditions.
Hair loss is usually diffused to the whole scalp, even in the posterior scalp. Despite its intense outbreak, patients can be reassured, as it is a reversible condition.
It is possible to distinguish between:
ACUTE TELOGEN EFFLUVIUM
The trigger usually takes place 2-4 month before the effluvium. It lasts a few months and the hair loss is diffused and abundant. Re-growing hair is usually shorter and thinner compared to the surrounding hair.
CHRONIC TELOGEN EFFLUVIUM
The name is due to the longer duration of hair loss. It can last months or even years if the trigger isn’t treated. In this case it is essential to carry out blood tests that can help find the cause and treat it in detail.
Also in this case the pathology is reversible, provided that the cause is identified and treated.
- Physical stress: pregnancy, surgeries, contraceptive interruption, physical traumas, abrupt and severe weight loss, high fever, etc.
- Pathologies: infectious diseases, thyroid diseases, malnutrition, intestinal malabsorption, etc.
- Psychic stress: traumas that might have had consequences from a psychological point of you, such as family, financial or emotional problems, accidents, exams, depression, etc.
The most effective treatment against Telogen effluvium or stress-induced alopecia is the elimination of its main cause. In any case it is necessary to carry out local and systemic therapies to make it easier for the patient to overcome the traumatic period of effluvium.
Therapies include topical and systemic cortisone products, dietary supplements in case of trace element deficiencies.
Scarring alopecia is a fairly common condition and is usually linked to autoimmune issues. Hair loss is followed by the creation of scarring tissue.
The following sub-categories belong to this big family:
- Lichen Plano-Pilaris
- Folliculitis Decalvans
- Discoid Lupus Erythematosus
- Pseudopelade of Brocq
Scarring alopecia always leads to an actual scar on the scalp and the following death of hair follicles and their ostium.
In this case the development of scar tissue represents the final and irreversible phase of the pathology, caused by the loss of the bulb stem cells.
The mechanisms that lead to this pathology are still unknown. The action of lymphocytes and neutrophils affects the hair follicle and causes an inflammatory process. The pull test will show that falling hair is in the anagen phase.
In order to treat this kind of alopecia it is essential to make an early diagnosis. Only a specialist in the field of trichology will be able to do that. By intervening at an early stage, it is possible to slow down or even stop the progression of the pathology, thus avoiding the final and irreversible scarring phase.
Thanks to the use of high resolution dermoscopes it is possible to identify the signature elements of scarring alopecia, that is: atrophic, shining and thin skin, absence of follicular ostium and just a few single hair strands.
A further pathognomonic sign is the presence of a single ostium with a lock of hair in the scarring area, whose presence is caused by the inflammatory melting process of hair follicles.
Aetiological factors and pathogenetic mechanisms are still unknown.
An inflammatory infiltrate of lymphocytes or neutrophils in the bulge area, where stem cells are present, causes the scarring process.
An early diagnosis allows the expert to define an effective therapy in order to stop the progression of the pathology and avoid the scarring phase.
That is why it is necessary to choose a specialized doctor who can recognize the symptoms.
Once the scarring phase is reached the only solution is hair transplant. However, it is important to underline that its success is 50% lower than in case of a hair transplant on a healthy scalp. Furthermore, the pathology must be stable for over 2 years.