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 Patchy Baldness
This condition affects about 0.1 % of the general population and appears suddenly as one to three bald patches. There are usually no symptoms and the person may be unaware of the hair loss until this is pointed out to them.
The patches may be white, smooth and completely bald or there may be black dots (representing broken-off hair stumps) or "exclamation mark" hairs (these are hair stumps with a thin base and a thicker brushlike end). Exclamation mark hairs are a sign that hair loss is still active and that the patch may extend in size.
There have been a few cases of alopecia areata affecting pigmented hairs alone and causing them to fall out, leaving only the white hairs. This can cause hair to "turn white overnight." Historical examples are Sir Thomas More and Marie Antoinette, whose hairs were reported to have suddenly turned white before their executions.
Alopecia areata usually affects the scalp in patches (Figs. 12 and 13). However, in a few patients, these may enlarge rapidly and merge together to produce complete baldness of the scalp-a condition known as alopecia totalis. Sometimes the alopecia is even more severe and spreads to affect the body hair as well. This causes a universal alopecia or alopecia universalis (Fig. 14).
In about 10% of patients, alopecia areata affects areas other than the scalp such as the eyelashes, eyebrows, beard (Fig. 15), pubic and body hair. Alopecia are at a may affect the nails in 10% of patients, causing pitting and ridging. A similar proportion of patients also suffer from atopic conditions such as atopic dermatitis (eczema), asthma (wheezy breathing) or allergic rhinitis (itchy, runny or stuffy nose).
Most cases of alopecia areata occur between the ages of 20AO years but any age, race or sex may be affected. A family history of this case is present in 10- 20% of patients, suggesting that the tendency to develop alopecia areata may be inherited. Identical twins have been reported to develop it on identical areas of their head at around the same time.
The cause of alopecia areata is unknown. The currently favoured theory is the autoimmune theory (meaning self allergy). According to this theory, the body's lymphocytes (a type of white cells) attack the hair follicles and cause hair to fall. Support for this theory comes from the following observations:
1) Microscopic examination of the affected skin (scalp biopsy) shows hair follicles surrounded by large numbers of lymphocytes. Lymphocytes are normally involved in immune reactions and their aggregation around the hair follicles suggest that they are participating in an immune reaction against the hair follicles.
2) Alopecia areata is frequently associated with other diseases suspected of having an autoimmune basis such as vitiligo (milky white patches of depigmented skin), thyroid disease, Addison's disease, pernicious anaemia and diabetes.
3) Steroids and other drugs which suppress the immune system appear to help alopecia areata.
However, why alopecia areat51 normally affects only certain patches and not the whole scalp defies explanation.
Emotional stress is believed to playa role. Patients with alopecia are at a sometimes recall a sudden stressful event a few weeks before its onset. You may recall that the hair of Sir Thomas More and Marie Antoinette suddenly turned white on news of their impending executions. It is believed that alopecia areata affected the pigmented hairs, causing them to fall off, leaving only the white hairs.
Although stress may playa role in precipitating alopecia areata, it is not the cause. That stress may precipitate alopecia areata is still not inconsistent with the autoimmune theory because stress is known to cause alterations in immune function.
In the past, doctors went to the extent of saying that alopecia areata was entirely due to "nerves." This is not only unkind but also scientifically incorrect.
One reason could be that some patients with alopecia areata appeared neurotic or depressed about their alopecia. However, this is understandable because hair loss is very distressing, even to the most stable of characters.
Another reason could be that doctors those days were unable to offer much treatment and used that as an excuse for not treating them. This is certainly not the case today. Modern doctors understand alopecia areata better and have more effective treatments at their disposal.
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