Several bald spots appeared on my head overnight. Is alopecia areata really "alopecia areata"?

Actress Shen Mengchen once posted a Weibo post saying that a piece of her hair suddenly fell out, and joked that "a scalp without hair is like Antarctica without penguins."

In fact, the phenomenon mentioned by Shen Mengchen is what ordinary people often call "alopecia areata", or alopecia areata.

01

What is alopecia areata

Alopecia areata has actually been known for a long time. The ancient Greeks called it “alopekia”, which means fox scabies[1]. This is because people discovered that when foxes get scabies, the hair on their heads will fall off, just like alopecia areata in humans.

Figure 1 Copyright file, unauthorized reproduction

Alopecia areata can occur in men and women of any age, and most patients are relatively young. Alopecia areata is also a common disease among children.

Alopecia areata often occurs suddenly. Many patients usually find that they have lost one or several coin-sized pieces of hair on their scalp when they wake up in the morning. The skin in the hair loss area is smooth, without inflammation, scales or scars.

Patients often do not have any special feelings when alopecia areata occurs, nor can they detect any abnormalities, so they always can't help wondering if someone shaved their hair while they were sleeping at night?

Alopecia areata can be mild or severe. Although it is not fatal, it can cause great mental stress to patients.

If a small piece of scalp falls off, like Shen Mengchen, it is a mild alopecia areata. In severe alopecia areata, all the hair will fall off, which is called alopecia totalis. In more serious cases, in addition to the hair, eyebrows, eyelashes, pubic hair, armpit hair, etc. also fall off, which is called universal alopecia.

According to the stage of the disease, alopecia areata can be divided into progressive stage, dormant stage and recovery stage.

During the progressive stage, the hair on the edge of the hair loss area becomes loose and falls off with a slight pull; during the static stage, the hair on the edge of the hair loss area is no longer loose; most patients enter the recovery stage after 3 to 4 months of static hair loss, and new hair will grow. Initially, it is fine, soft and light-colored hair, which gradually becomes thicker and darker in color, and finally completely returns to normal.

02

Why does alopecia areata occur?

So, what causes alopecia areata?

It is generally believed in medicine that alopecia areata is a common skin disease and a specific autoimmune disease of hair follicles.

We can understand it this way: it is because the local hair follicles are attacked by some immune cells. In this state, this part of the hair suddenly goes from a growth state to a resting state.

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Studies have shown that most alopecia areata is caused by a combination of genetic and environmental factors[1].

Genetic factors are the most important cause of alopecia areata. About 1/3 of alopecia areata patients have a family history of alopecia areata, and the common incidence rate among identical twins is about 55%. If alopecia areata appears in childhood, the probability of inheritance is higher.

In addition to family inheritance, it may also be caused by an individual's combined immune-related diseases, such as hyperthyroidism or vitiligo, which cause immune hair loss diseases.

Traditional Chinese medicine believes that "the liver stores blood, the kidney stores essence" and "hair is the surplus of blood". In other words, if the qi and blood are sufficient, the hair will grow well; conversely, insufficient qi and blood will cause hair loss and form alopecia areata. In addition, alopecia areata is also related to internal dampness and heat, blood heat generating wind, liver stasis, spleen deficiency and qi and blood deficiency.

When people are under great mental stress, anxious, or angry, a large amount of toxins will be secreted in the body, which will damage the liver and lungs, cause turbid air to rise, and lead to poor circulation of qi and blood in the head, endocrine disorders, abnormal metabolism, and abnormal skin conditions.

03

How to Treat and Prevent Alopecia Areata

If you unfortunately suffer from alopecia areata, don't worry too much. The treatment of alopecia areata is mostly very effective and has no effect on physiological functions. You only need to conduct necessary examinations under the guidance of a doctor to rule out the possibility of other diseases.

Figure 3 Copyright image, no permission to reprint

Usually, with normal treatment, the hair of more than half of patients can grow again within 6 to 12 months.

Milder cases of alopecia areata can even heal themselves, but this takes time, because after a rest period of 3 to 4 months, the hair will enter the next growth cycle, and new hair will gradually grow again.

Almost all patients with alopecia areata do not require surgical treatment.

To achieve better results in stopping hair loss and promoting hair growth, patients can be given some super-strong hormones topically, such as halometasone cream, or combined with topical minoxidil ointment; or they can be given local injections of some hormone-containing solutions, such as depoxetine or triamcinolone acetonide solution [1].

If the alopecia areata is severe, the patient may need to take oral glucocorticoids for a short period of time, or use JAK inhibitors to achieve the effect of hair growth [1]. Severe alopecia areata and alopecia totalis are usually more difficult to treat, and the treatment cycle is also longer, usually more than a year.

It should be noted that alopecia areata is prone to recurrence. If early treatment is not thorough or the cause is not completely removed, alopecia areata is likely to come back.

For some patients with recurring hair loss, or patients with a larger area of ​​hair loss, or patients with a young age of onset, recovery time may take longer.

There is a folk remedy that involves applying ginger to the area where hair is falling out. Applying ginger to the scalp can warm the local skin and promote blood circulation. However, it was later discovered that 6-gingerol, the main ingredient in ginger, may cause hair loss, so Western medicine does not recommend using ginger to treat alopecia areata.

So how to prevent alopecia areata?

We cannot control genetic and autoimmune factors, but in our daily lives, we should pay attention to adjusting our diet and sleep, learn to relieve mental stress, avoid staying up late and irregular work and rest, all of which will help prevent alopecia areata.

If you really have alopecia areata, you should relax, adjust your mentality, and actively cooperate with the doctor's treatment. During the treatment process, you should also closely observe changes in the condition, have regular checkups, and stay positive and optimistic.

Author: Wu Yan, Chief Physician, Department of Dermatology, Peking University First Hospital

Reviewer: Guo Shubin, Chief Physician of the Emergency Department, Beijing Chaoyang Hospital, Capital Medical University

References

[1] Trichology Group, Chinese Society of Dermatology and Venereology. Chinese Guidelines for the Diagnosis and Treatment of Alopecia Areata 2019. Journal of Clinical Dermatology, 2020, 49(2): 69-72.