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Sunday, March 7, 2010

Alopecia Areata


What is Alopecia areata?

Also known as “Khalitya”  in Hindi and “Undari” in Gujarati. It is a non-scarring, T-cell ( a type of white blood cells in blood responsible for body protection)  mediated auto immune (The immune system, meant to attack the viruses and bacterias,  
mistakenly attacks the hair follicles, causing hair loss),  inflammatory hair loss disease affecting 0.1%–0.2% of humans some of them have Genetic predisposition (families of affected people show a history of alopecia areata.) , occurring in both males and females, though far more females than males and starts at younger age commonly but can start at any age. It occurs in people who are apparently healthy and have no skin disorder. It starts as a patchy hair loss in one spot (Alopecia areata monolocularis ) or more spots (Alopecia areata multilocularis) and may progress to entire head (Alopecia areata totalis) different sites of body involving beard (Alopecia areata barbae) , eyebrow, moustache or pubic hair and can even progress to entire body hair loss (Alopecia areata universalis). OPHIASIS (which literally translated from the Greek means snake and referes to the winding or bow-like spread of hair loss around the margins of the scalp. It is most commonly seen as a band affecting the back and sides of the head (otherwise known as the occipital and temporal regions). RETICULAR(describing a reticular or grid-like hair loss. Patients with reticular alopecia have many patches involving most of the scalp. Due to the infrequency of this subtype and its similarity to hair loss of different causation a skin biopsy is usually ordered to clarify the diagnosis), A DIFFUSE form is seen after recurrent bouts of hair loss followed by partial regrowth. In affected regions, short hair often intermixes with longer hair. The appearance of the scalp is one of thinning rather than a bald patch. Again, because of similarities with other types of hair loss, a skin biopsy may be ordered to clarify the diagnosis.
Although not fatal, the resulting disfigurement poses psychological and sociological problems for the patient.

Prognosis of Alopecia Areata
The progress of alopecia areata is unpredictable. Some people lose hair in only a small patch. Others may have more extensive involvement. Alopecia totalis is the loss of 100% of scalp hair. Alopecia universalis is the loss of 100% of body hair. These last two conditions are rare. In the majority of patients, the hair will regrow completely within 1 year without any treatment.
Episodes of alopecia areata before puberty predispose chronic recurrence of the condition. Pitting of the fingernails can hint at a more severe or prolonged course.
*      25% of patients develop a single episode
*       65% exibit spontaneous regrowth in 1-2 years after development, one third of patients the initial patch never exhibits evidence of regrowth
*       35% persists, progress or cyclical expression & remission
*       7% progress to Totalis or Universalis
*       Earlier the onset of symptoms the worse the prognosis.
*       Recurrences are possible even after a 20 year remission
*      Reticular & Ophiasis are difficult to treat
*       Patient with genetic predisposition to Atopy hayfever, asthma, and eczema alopecia areata have a more severe or resistant form of alopecia areata
*       8% have Thyroid disease but thyroid treatment does not affect AA
While the disease itself is not damaging to bodily health in any other way, apart from possible changes in the appearance of the nails, coping with hair loss can prove challenging.

 

What causes it?

The body’s immune system wrongly attacks the growing cells in the body’s hair-producing `follicles’ (medical word for the roots or seed of the hair), where the hair starts to grow. This stops them producing new hair and causes existing hair to fall out. The cells which produce the hair, the follicles, do still remain active so the potential for hair to start re-growing is always there. A person’s ethnic origin, social status, their sex or age has no apparent bearing on the likelihood of them suffering from Alopecia.
Many issues remain unresolved about; what causes this disease? It is believed due some genes that cause this abnormal immune response ; then what are those genes? According to some, environmental factors like chemicals, vaccines and desensitizing injections may also trigger this disease. Some specialists opine that viral and bacterial diseases could cause the immune system to behave aberrantly against the hair follicles. Then there are cases which show stress and anxiety can cause this disease.

How common is it?

There are varying figures available, but it is commonly accepted that something approaching 1.7% of the population will have alopecia to some degree during their lifetime. This includes more than 4 million people in the United States, with both men and women being equally affected. About 25% of people with alopecia have a family history of the disorder

 

Is it hereditary?

Susceptibility can be affected by hereditary (inherited) genes in as much as they are thought to influence the likelihood of getting Alopecia. About 25% of patients have a family history of the disorder (Bertolino, 2000). However, your genes alone are not going to make Alopecia occur. Neither are you going to pass on an `Alopecia gene’ to your children. It is thought that there is a combination of genes which predispose you to the condition, meaning it is possible you may have the symptoms at some point in your lifetime.

 

Why did I get it?

Over 20% of people with alopecia have a family member with it. If you have had eczema, asthma or a thyroid disease you are more prone to Alopecia. However, the majority of people with alopecia are not aware of being in either of these categories and susceptibility is then probably due to their combination of genes. Some studies show a link with stress or trauma.

 

What treatments are available?

There is no cure for alopecia and no universally proven therapy to induce hair re-growth and sustain remission. However, there are treatments. The effectiveness of treatments tends to vary and something that works well for one person may not work well for another. So if you find one treatment doesn't work, don't assume others won't either. But bear in mind that for some people none of the treatments are effective. And of course no treatment at all is another option.
  • CORTICOSTEROIDS : Local applications like ointment, cream etc., Interalesional injections, systemic injection or oral use
  • PUVA  with Psoralene, or Sunlight
  • CONTACT SENSITIZERS diphencyprone or DPC.; Squaric acid dibutylester or SADBE; dinitrochlorobenzene or DNCB
  • CHEMICAL IRRITANTS : Minoxidil, Anthralin, Retin A, Aromatic volatile oils, Dithranol
  • Immune modulator:  cyclosporine, sulfasalzine Tacrel .03/1 %
  • Future treatment: gene therapy, Interleukin injections or the administration of their cDNA sequences

 

What are the alternatives to treatments?

If there are just a few bald patches, you could try an eyebrow pencil, cream or spray of the same colour as your hair to make the patches less obvious. This works by reducing the colour contrast between the skin and hair. An alternative is to use a keratin microfibre product such as Toppik or Nanogen which is sprinkled onto the scalp and binds to each hair fibre, giving a camouflage and more natural weight and density. Dividing your parting slightly differently can help to cover up bald patches. Use volumising shampoos and conditioners as these can also give the appearance of more hair and a fuller and thicker head of hair.


Some people wear bandannas, a scarf, a hat or wigs (some of which can stay on for swimming and in the shower). These can be combined with treatments too of course. Some people with alopecia are happy to do nothing.
Some people shave off the head to make patchy loss less noticeable. If you have a lack of hairs on your eyebrows you could try an eyebrow pencil. Find an eyebrow or eyeliner pencil that is similar in colour to your hair/wig hair colour, failing this go lighter and not darker. When drawing the eyebrow, use the bone above the eye socket as a guide for the shape of the eyebrow. Using hairspray over eyebrow pencil makes it last longer and will also make it more resistant to perspiration. If eyebrow pencil does not suit you, you can buy fake eyebrows which come in a variety of colours, shapes and lengths. They are self adhesive, can last up to three days and are waterproof. There are companies which replace missing eyebrows with a method similar to a tattoo, called semi-permanent make-up. It is also called micropigmentation. It can normally look good for up to a year, when it can be partly refreshed or renewed. It can be quite expensive. Fake eyelashes made of both synthetic and real hair are widely available on-line and in high street chemists. They can be quite tricky to apply to start with but can look very realistic with a bit of effort. With fake eyelashes try using eyeliner and mascara for a more realistic look. Start with simple eyelashes, don’t go too over the top as they will look less natural. For the eyelashes use the Dark Glasses.

Can I have Hair Transplantation In Alopecia Areata?
The patients with AA that are generally accepted for surgical hair restoration are those with one or a few small patches that have remained unchanged and have not been treated medically for several years. This is usually a minimum of two years. With one operation we can achieve about 30% of the original density so some patients may require 2 operations to achieve a thicker look. Unfortunately it cannot be guaranteed that the hair will be permanent as the disease process can recur at any time. But for some patients even a temporary return to ‘normal’ hair is acceptable.

 

When will my hair grow back?

The vast majority of people with alopecia experience some degree of re-growth. The growing cells that supply the hair follicle remain active, so the potential for hair to re-grow is always there. There is a possibility of complete re-growth. But you may also experience the condition worsening or improving at any time. It is unpredictable, which is one of the most difficult aspects of the condition - nobody can tell you with certainty what the pattern of your alopecia will be. So, at the extremes of the condition, you may have a single patch with complete re-growth within a short time and no further occurrence; or you may, as in a small minority of cases, experience all your body hair being lost with no re-growth at any time. It is most common to experience hair loss and re-growth over many years. The re-growth can be any texture and colour, from fine-downy hair that's white, to hair identical to your original hair colour and texture.

 

Is there anything that can help me cope with the affects of alopecia?

You are not alone. There are millions of people with Alopecia in all corners of the world, including over 4 million in the United States. Reading their stories or comments on-line, on discussion boards and in chat rooms will show you how other people are coping in their various ways throughout the world. That is not to say it isn’t an upsetting condition or that you won’t have times when you find it difficult. On the positive side it is not contagious, not painful, and there is no reason why, even though you have Alopecia, you can’t do all the things you did before its onset. People with alopecia continue to go to school or work, fall in love and have healthy, happy families of their own.
If you want to wear a bandanna, a scarf, a hat or a wig, or proudly show your bald head go ahead and do what makes you feel better about it. There are organizations that have other suggestions, or you might like professional help or advice which you will need to check.
Put your own feelings up on a discussion board. It helps to say how you really feel to other people in the same situation, who will understand exactly what you’re saying. This can sometimes be the best free therapy available!
Try to keep smiling and release some feel-good endorphins. Laughter will probably have a positive effect on your health.

 

How can I get more information?

Website and organizations that help:

http://www.help4alopecia.com/
http://www.naaf.org/site/PageServer?pagename=homepage
National Alopecia Foundation - The international center for Alopecia Areata information and probably the best source of information about Alopecia Areata.
Alopecia Areata Support Community - Alopecia Support Community for all people living with Alopecia Areata (AA), Alopecia Totalis (AT) and Alopecia Universalis (AU) and AGA (as well as their family and friends!). Share your stories and find support through the message board, post your photos and make new friends! This community was created on the principle that by helping others we help ourselves. Please use this community as if it were your very own place to share your fears, share your joys, and vent your frustrations
British Association of Dermatologists - An excellent leaflet on Alopecia Areata recommended by many dermatologists.
Alopecia Online - Probably the best resource for Alopecia Areata in the UK.
Childrens Alopecia Project - A non profit organisation aiming to create public awareness of the disease and to raise money for research and build Self-esteem via support group participation for children and their parents.
Locks of Love - A non-profit organization that provides hairpieces to financially disadvantaged children across the U.S. under age 18 suffering from long-term medical hair loss.
Komfy Kids - Therapeutic aids for children dealing with hair loss. Great teaching tool for schools and groups.
Institute for Traditional Medicine - Treating Alopecia with traditional chinese herbs.
Her Alopecia - Women’s Hair Loss Information and Support. Contains an active forum.
Alopecia Ireland - dedicated to providing support and information to people with Alopecia Areata, Totalis and Universalis in Ireland and the rest of the world.
Skin Care Campaign (http://www.skincarecampaign.org/)
The Skin Care Campaign (SCC) is an umbrella organisation representing the interests of all people with skin diseases in the UK. Established in 1992, it is a subsidiary of the National Eczema Society, a registered charity. Alopecia UK is a member organisation of the Skin Care Campaign.
British Skin Foundation (http://www.britishskinfoundation.org.uk/)
The British Skin Foundation exists solely for the purpose of supporting research into skin disease. Working closely with patient support groups (including Alopecia UK) as well as many of the country's leading dermatology departments, the Foundation aims to help the 7 million people in the UK who suffer with a serious skin condition.
British Association of Dermatologists (http://www.bad.org.uk/)
The British Association of Dermatologists is the central and long-established association of practising UK dermatologists, it aims to continually improve the treatment and understanding of skin disease.
Changing Faces (http://www.changingfaces.co.uk/)
Changing faces is a charity aimed at helping people face disfigurement with confidence. While the site itself doesn't have anything specific to alopecia, a lot of the general information is very relevant. The site is easy to use and has a good range of links.
Outlook (http://www.nbt.nhs.uk/services/surgery/outlook/Default.htm)
Outlook is a psychological support service for anyone affected by a disfigurement or visible difference. The service is based at Frenchay hospital in Bristol. The website doesn't have much information, but for people in the right area, who are finding it difficult to cope with their hairloss, a referral to this service could be very helpful. This is the only NHS funded service of this kind in England.
National Alopecia Areata Foundation (http://www.alopeciaareata.com/)
A very good site with extensive information for people suffering from alopecia. The site is an American site and subsequently some parts of this site are more useful for people living in the USA. However they will send information to the UK but in order to join they need a membership fee in dollars.
Follicle (http://www.follicle.com/)
This has a range of advice but is centered around androgenetic alopecia or male pattern baldness.
Alopecia Help and Advice (http://www.alopeciascotland.co.uk/)
Alopecia Help and Advice (Scotland) is a locally based charity setting out to help people suffering from Alopecia Areata. It was set up by the mothers of two girls with Alopecia Areata who live in Grangemouth and Edinburgh.
Keratin (http://www.keratin.com/)
A website full of information for all types of alopecia. It has a selection of discussion boards and information on hair.
Alopecia Areata Support Association (http://home.vicnet.net.au/~aasa/)
The AASA is an Australian voluntary group established to provide information and support for people with alopecia (areata, totalis or universalis), and their family and friends.
Alopecia Areata Support Community (http://alopeciasupport.multiply.com/)
A support community for all people living with alopecia (as well as their family and friends!). Here you can share your stories and find support through the message board, post your photos and make new friends.
Nathan Prince (http://www.alopeciaboy.net//)
Has a very good, upbeat site-within-a-site on his `alopecia page'. Will bring a smile to your face on a down day. Good, useful information. Site based in Montreal, Canada.
Her Alopecia (http://www.heralopecia.com/)
A women only website. It is a place to find information and to talk to other women with alopecia.
Harry's Alopecia Page (http://www.alopeciaareata.nl/)
A personal site by Harry with lots of information and his personal story.
Alopecia Ireland (http://www.alopeciaireland.org)
A great site with some fantastic pictures of famous alopecians. Well worth a look.
·        Cicatricial Alopecia Research Foundation (http://www.carfintl.org)
A site for people with Cicatrical (scarring) alopecia. This is an excellent organisation which raises money for research into this rare form of alopecia.
For best on FAQs:

Does anybody know the statistics that would tell me what are the chances of passing along alopecia to my kids?

The risk of someone with AA having a child with AA is actually very low to non-existent. The risk is not more than 4% when looking at the statistical analyses in a variety of published reports. Some reports suggest the risk is no greater than the life time risk for the general population (1.7%). Having AU apparently presents no greater or lesser risk of transfer than someone with patchy AA.
I suspect there are multiple susceptibility genes for AA, different combinations of which may be found in different people with AA. However, it is clear that having susceptibility genes is not always enough for overt disease to develop. There are probably environmental trigger factors interacting with susceptibility genes to promote onset of AA.
If you do have genes for AA susceptibility it is possible you will not pass all of them on to your child plus your child may not receive an appropriate environmental stimuli for AA onset. Your husband's genes may also mask any potential susceptibility genes. With all these possible interactions and for so many factors to come together at the same time in one individual it is not suprising that the risk of passing AA from parent to child is so low to be effectively non-existent.

Some good things and bad things about alopecia

Bad things:
  1. Staying at someone's house and leaving behind enough hair to knit a sweater. I always wonder what they think of me after I leave.
  2. The feeling of helplessness and loss of control. No one likes to be told that there is no answer, especially when we are talking about our own body.
  3. Covering up the spots. If your hair is straight when short but curly when long and trying to cover your spots, then this is a very frustrating endeavor (especially on humid days).
  4. Explaining it over and over again. This is specially true for those that don't believe the hair is falling because of an allergy or autoimmune condition. You tell them that your hair naturally doesn't grow and they don't believe you!
  5. Standing in a crowded place. If your spots are on the back of the head, you may wonder what people behind are staring or thinking.
  6. Wearing a wig. Many people can't wait to get it off at the end of the day!
  7. When people assume that you are either dying, a skinhead or trying to make a personal statement, when they are so far from the truth. If I want to make a statement I'll say something.
  8. When someone you've just met is talking to you for the first time and they look at the top of your head and not in your eyes
Good things:
  1. Being on this list server. Every story, from tear jerker to humorous anecdote, the sharing of ideas and giving advice, and the quest to find a cure for treatment. In every case there has been something good and inspiring.
  2. Learning quite a bit about medicine and nutrition.
  3. Not having to shave your legs or having your hairs pinched by your watch or bracelet. Having that supersmooth skin without any stubbles.
  4. It is sometimes easier for your friends to spot you in a crowd.
  5. Some people may be either amazed or fascinated by you- they think that you are special, different, lucky, sexy, and blessed.
  6. Your eyes and your smile are more noticeable.
  7. Learning to love yourself. "I'm attractive. People always tell me I should model - maybe I should."
  8. You may look really mean when you want to. This is particulary handy when you are filling the gas tank late at night and alone.
  9. It only takes half an hour to get ready for work in the morning.
  10. You don't have to ride in the rollercoaster that you are afraid of- instead tell your friends it is because you fear your wig will fall out.
  11. Allows the experience of fresh air and wind in your face to be pure ecstasy.



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