Even Children Are Susceptible to the Trauma of Hair Loss
Hair loss can be traumatic at any age, and not only for men who slowly watch a bald spot spread across their heads. The technical name for hair loss is alopecia, a Latin term that refers to baldness in any form. Alopecia areata is a condition that affects an estimated 2% of the population, or 4 million Americans, including children. Affected people may lose hair in round, totally bare patches, and in severe cases may lose not only the hair on their heads but also eyebrows, eyelashes and all body hair.
Health spoke to Dr. Vera Price, who in 1981 co-founded the National Alopecia Areata Foundation, or NAAF, now based in San Rafael, Calif. She also directs the Hair Clinic in the department of dermatology at UC San Francisco, as well as the UCSF Hair Research Center.
Question: Could you describe the three kinds of alopecia?
Answer: Alopecia areata occurs in a patchy form that results in round, smooth coin-size patches of hair loss on the scalp or any hairy area such as the beard; it also may result in total loss of all hair on the scalp, called alopecia totalis; and the most extensive form, in which all hair on the scalp and entire body is lost, is called alopecia universalis.
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Q: How do you know when it’s alopecia areata and not just normal hair loss?
A: In alopecia areata, the skin that is affected is suddenly “bare as a baby’s bottom,” sometimes in dime-size patches or silver dollar-size patches. Nothing else causes completely bare patches like this.
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Q: Are there other diseases and medical ailments associated with alopecia areata? Is it sometimes a sign that something else is wrong?
A: Alopecia areata usually occurs in completely healthy people. The only conditions that occur more frequently are eczema, asthma, hay fever and thyroid problems.
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Q: There are no adverse physical effects associated with alopecia areata, and yet the psychological stigma of hair loss, especially for children or women, can be quite severe. How do you address that in your treatment?
A: It is important to point out that alopecia areata, though harmless to one’s health, may nevertheless be a life-altering condition. When loss of hair is visible to others, it can be a devastating experience. It takes time to adjust to this loss, just as it takes time to grieve for the loss of a loved one. It is important for the person and family to have all the facts correct, to know it is not contagious and it occurs in healthy people, that it was not someone’s fault and that the possibility for complete hair regrowth is always there. Having correct, up-to-date information is an important first step. A schoolchild needs to have the correct information about alopecia areata brought to the teacher, classmates and parents of classmates. Friends need to know that the person is not sick, is not having chemotherapy and wants to be treated just the same as before the hair loss.
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Q: What is the prognosis for people with alopecia areata? Does it ever just go away? And is there any cure?
A: Alopecia areata is an unpredictable disease. It can turn itself off and the hair can regrow as quickly as it was lost--and the hair can fall out again at a later date. In fact, it is this unpredictability that makes alopecia areata so difficult for those who have it. One does not know when the hair might regrow, and when it might fall out again. We have ways of controlling alopecia areata, ways of promoting or stimulating hair regrowth with various treatments. But all treatments must be continued until the alopecia areata turns itself off--that is, until there are no remaining bare spots. In medicine today, it is good to remember that there are no cures for most conditions (such as diabetes mellitus or high blood pressure)--we control these conditions rather than cure them; the exceptions are infections, which are mostly curable, and growths that can be cut out with surgery.
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Q: So is there anything that can be done? How about wigs or Rogaine? Changes in diet or lifestyle? If not, then what cosmetic options do you recommend?
A: Treatments include cortisone injections into the bare, affected areas, Rogaine 5% solution applied twice daily, anthralin (a tar-like cream), sensitizing and challenging with allergenic compounds like diphencyprone or squaric acid dibutyl ester. These treatments all work best in the mild, patchy alopecia areata rather than in the most extensive forms. Changes in diet and lifestyle do not turn off the disease. There are many cosmetic options until hair regrowth occurs; when brows and eyelashes are missing, good eye and facial makeup make a huge difference. Wigs, hairpieces, scarves, caps, hats, or no head cover--whatever is the preference--are all good.
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Q: Who gets alopecia areata? Is it mainly older men? How many women and children?
A: Males and females are affected equally. Alopecia areata occurs at all ages, but children and people under 30 are affected most commonly.
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Q: I understand that the NAAF and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, which is a division of the National Institutes of Health, are engaged in research for a cure. Could you discuss the specifics of the studies or research and what advances we can expect?
A: NAAF funds research each year to help understand what causes alopecia areata and why some people are more susceptible to it--and the ultimate aim of all the research is to find a cure or highly specific and effective treatment. In 2000, NIAMS funded a National Registry for Alopecia Areata, which will help the search for the genes involved in alopecia areata and will lead to the ultimate treatment or cure.
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For more information on alopecia areata, contact the National Alopecia Areata Foundation at (415) 456-4644 or go to https://www.naaf.org.
