How Many Types of Alopecia Areata Are There?

Alopecia Areata (AA) is a very common hair loss condition that is said to affect about 7 million people in the USA alone. It is the second most common cause of baldness, being ranked right after male and female pattern baldness.

Alopecia Areata is an autoimmune condition, meaning that the body’s immune system is fighting off its own components. In the context of Alopecia Areata, the body’s white blood cells start fighting the hair follicles, which are responsible for causing the hair to grow. As a result of the hair follicles being damaged, hair growth is arrested and the result is bald patches of hairless skin.

Although it can affect any hair-bearing part of the body, it is most commonly seen on the scalp.

Being an autoimmune condition, Alopecia Areata has no definitive cure, but several treatment modalities work together to trigger the right kind of stimulus which causes the hair to start growing back.

Types of Alopecia Areata 

Alopecia AreataMost commonly beginning as the loss of hair in small patches, Alopecia Areata could be subdivided into many different types. The most common types of AA are enlisted as follows:

Patchy Alopecia Areata:

This is the most common type of Alopecia Areata. In this type of AA, hair loss is noticeable in the form of multiple, small, round to oval, patches that are spread throughout the scalp, or any other affected region. These patches of hair may remain at some distance from each other or may join each other to form a single large patch.

It can affect people of any age. Most commonly, it males.

Treatment:
People who are suffering from the patchy variant of Alopecia Areata are given corticosteroid injections. These injections are considered to be the most effective treatment in stimulating new hair growth from bald patches. A research study revealed that approximately 80% of people who received corticosteroid injections noticed significant hair growth within 3 months of getting injected.

Alopecia Totalis:

Alopecia Totalis, or Total Alopecia, is the complete or nearly-complete loss of all hair scalp hair. It could be a progressive form of the normal Alopecia Areata, or it could occur spontaneously too. 

Many people suffering from Alopecia Totalalis experience itching or a tingling sensation in their scalp. Even though it is an autoimmune condition, Alopecia Totalis is linked with a strong family history, meaning that if a family member has this variant of Alopecia, then it is quite likely that other family members might be affected by this condition too.

It can touch people of any age group, however, males between 15-30 years old are affected more than others. 

Treatment: 

For Alopecia Totalis, a Pulse-Steroid Therapy is employed. This is a topical therapy where a steroid is applied onto the scalp. The steroid causes an allergic reaction on the scalp, which could tone down the autoimmune reaction, and thus, help in regrowing the hair.

Although considered to be a short-term effective treatment, there are still many ongoing debates regarding its efficacy and safety for the general population.

Other than that, Methotrexate is also used for treating Alopecia Totalis.

Alopecia Universalis:

Alopecia Universalis is the complete or nearly-complete loss of hair from all the hair-bearing surfaces of the human body. It is considered to be an advanced form of Alopecia Areata. 

Alopecia Universalis might be linked to several allergic conditions that affect the body, including Atopic Dermatitis, Thyroid Disorders, Personality Disorders, etc. The cause behind Alopecia Universalis is multifactorial. It has both a genetic and environmental background, and could also occur due to family history.

Treatment: 

Different treatment options are used to treat the condition or to lessen its effects. These include Phototherapy, Pulse-Steroid Therapy, and Cyclosporine-Steroid combination. 

Alopecia Incognito:

Alopecia Incognito is an acute, spontaneous onset of Alopecia. It is found most commonly in women under the age of 40. Unlike the other variants of Alopecia, there is no patchy loss of hair. In this subtype, there is an abrupt and intense loss of hair from the scalp.

Dermoscopic findings have revealed this form of Alopecia presents with yellow dots on the scalp. Along with that, the regrowth of short, new hair could also be seen in this variant.

Treatment:

The treatment options widely consist of Steroids. These steroids could be given in different forms – intramuscular, oral, topical, etc. Steroid therapy is very effective for Alopecia cases.

 

Some Uncommon Variants of Alopecia 

The above mentioned variants of Alopecia Areata are the most commonly encountered ones, however, there are also some other rare forms of the disease which a patient may develop. These rare forms include:

  • Sisaipho:
    This form of Alopecia refers to the extensive loss of hair from the scalp, leaving the periphery unaffected.
  • Ophiasis:
    This refers to Alopecia occurring in a band-like pattern around the head. This band-like pattern usually surrounds the temples and backside of the head (temporal and occipital lobes).

Can Alopecia Areata Be Reversed? 

If this question was raised a decade ago, the probable answer would have been a ‘No’. This is because, in the past, only supportive treatment for the underlying causative diseases was prescribed, so either the medication improved the Alopecia, or it had no effect at all.

Nowadays, scientists have carried out successful trials with a drug called Ruxolitinib, which was previously used for the treatment of bone marrow disorders. In this experimental study, when this drug was given to a 9-year old boy, in a twice-daily dosage of increasing dose levels, nearly-complete hair regrowth was noticed after 4 months. No side effects were reported.

This gives hope and makes dermatologists confident that with further research and trials, a successful treatment therapy could finally be introduced to treat this condition.

 

 

References: 

  1. Pratt, C. H., King, L. E., Jr, Messenger, A. G., Christiano, A. M., & Sundberg, J. P. (2017). Alopecia areata. Nature reviews. Disease primers, 3, 17011. https://doi.org/10.1038/nrdp.2017.11
  2. Aslam, A., & Harries, M. J. (2013). Patchy hair loss in an otherwise healthy man. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 185(18), 15911592. https://doi.org/10.1503/cmaj.130305
  3. Shreberk-Hassidim, R., Ramot, Y., Gilula, Z., & Zlotogorski, A. (2016). A systematic review of pulse steroid therapy for alopecia areata. Journal of the American Academy of Dermatology, 74(2), 3724.e45. https://doi.org/10.1016/j.jaad.2015.09.045
  4. Molina, L., Donati, A., Valente, N. S., & Romiti, R. (2011). Alopecia areata incognita. Clinics (Sao Paulo, Brazil), 66(3), 513515. https://doi.org/10.1590/s1807-59322011000300027
  5. Peterson, D. M., & Vesely, M. D. (2020). Successful treatment of alopecia totalis with ruxolitinib in a preadolescent patient. JAAD case reports, 6(4), 257259. https://doi.org/10.1016/j.jdcr.2020.02.007