What is Alopecia Areata?
Alopecia Areata is an autoimmune disease in which the body sees hair follicles as outer hairs and launches an immune attack on the follicles, causing the hair to fall out. Unlike other forms of hair loss, hair follicles are not permanently damaged in Areata. This means that under the right conditions, the hair follicles have a chance to recover. This is different from some other types of hair loss, once it starts, it usually continues and there is not much hope for long hair.
Is there a treatment to promote hair regrowth?
It is already approved for rheumatoid arthritis and more recently for hospitalized Covid patients because it suppresses the inflammatory response in the body. Our lab was the first to show that the drug also inhibited immune challenge in mice with alopecia. Many in our field have worked really hard to get the first approved drug for this year’s hair loss. Better get the first drug approval, maybe some more in the next year or so. The patient is happy.
How common is Alopecia Areata? Is any particular demographic at risk?
People often do not seek treatment for hair loss because until now, treatment options have been limited, especially for patients with severe hair loss. Or, they have only one spot on their beard or a small spot on their head and won’t seek treatment. It is roughly the same in men and women. Several recent papers have reported slightly higher rates in the African-American population, but this is small.
Do we know what causes the disease?
We now know that hair loss is a disease caused by a combination of genetic susceptibility and environmental triggers. In children with Alopecia Areata, when it occurs early in life, it tends to be more severe, so thinking is that there are more genes for sensitivity, and perhaps less contribution to environmental influences. On the other hand, in people with adult hair loss, it may take longer for their specific genes (in combination with environmental factors) to trigger the disease.
Is the disease the same for those who lose all their hair on their entire body? Is this just an improvement?
We think of Alopecia Areata hair loss as a continuum, from mild to severe disease. When people start with patchy hair loss, in some parts of these patients, the disease will go away spontaneously. For others, it may come and go for a long time. In others, the disease will involve the entire scalp or the entire body. We don’t yet know what the drivers are those determine this, but we believe that here, environmental factors combined with genetic susceptibility determine the final outcome and severity of hair loss.
What’s the significance here that alopecia Areata is an immune system sickness?
Basically, this means that the body’s immune surveillance system for danger has emerged. Something in the follicle seems to be starting to identify as foreign. It is believed that the hair follicles mistakenly send a danger signal to the immune system, which activates immune cells to kill the follicles. These are signals used by infected, cancerous or dying cells to destroy the immune system of their targets. But when the same thing happens in normal healthy tissue, the result is an attack of autoimmunity, or a faulty immunity to one’s own tissue.
Do we know anything about the environmental triggers?
We do know one thing. In the early days, there were reports that dust mites, cytomegalovirus or Epstein-Barr virus might play a role. An area of interest to many of us right now is the microbiome. Skin diseases such as psoriasis or atopic dermatitis are associated with the skin microbiome, but our work shows that in alopecia areata, the gut microbiome is associated with the disease. So the microbiome appears to be at least an environmental factor.
There are also numerous reports that stress can trigger or worsen the disease. Usually not overnight – there is usually a lag. A patient would come in and say I had a stressful event three months ago and now my hair is falling out.
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