Etiology and Clinical Presentation:
Alopecia areata is an immune-mediated inflammatory disorder characterized by hair loss, which can occur in small patches or over large areas of the scalp, body hair, eyelashes, and/or eyebrows. Most patients who develop alopecia areata are under the age of 30, but it can begin at any age. Alopecia areata can be self-limiting - 50% of patients will see complete hair regrowth within 1 year without treatment, but most will relapse months or years after remission. The exact mechanism of alopecia areata is unknown, but we do understand that there is an inflammatory immune response around the hair follicle, which leads to damage and eventually hair loss. There are no biological markers to detect alopecia areata, but there are known risk factors, including: family history of alopecia areata, comorbid asthma, hay fever, atopic dermatitis, thyroid disease, vitiligo, or downs syndrome. Alopecia areata can also be drug-induced - this is commonly seen with chemotherapeutic agents such as nivolumab (nivolumab-induced alopecia areata). Your race may also affect your risk of getting alopecia areata. In a large study, researchers found that black and Hispanic nurses were more likely than non-Hispanic white nurses to develop this disease. The decision to treat alopecia areata should be done based on severity of the disease and psychosocial implications of hair loss in young adults. For example, an older male adult may not request treatment, but a 20-year old patient may become extremely distressed by repetitive loss of hair. Below is a summary of treatment strategies currently recommended for alopecia areata:
Investigational and Approved Treatment Options for Alopecia Areata (2021)
Resources:
Messenger A. Alopecia areata: Management. UpToDate. https://www-uptodate-com.jerome.stjohns.edu/contents/alopecia-areata-management?search=alopecia%20areata&source=search_result&selectedTitle=1~60&usage_type=default&display_rank=1. Last Updated 03/03/2021.