You may not have heard of alopecia, but it is likely that we all know someone who suffers from this common disorder. Mary Gail Mercurio, M.D., a professor of Dermatology, specializes in hair loss and regularly treats patients with the condition. She answers common questions about alopecia and alopecia areata, an autoimmune condition that actress Jada Pinkett Smith has championed since she revealed her own diagnosis in 2018.
What is alopecia?
Alopecia is a very broad umbrella term for all causes of hair loss. It is non-specific and includes the whole gamut of hair loss causes ranging from the hair shed that occurs after pregnancy, to male-pattern balding, to hair breakage from over-processing, to chemotherapy-induced hair loss and more. Some types are temporary and reversible and others are permanent. Unsubstantiated media reports suggest Jada Pinkett-Smith has a particular variety called alopecia areata. This type falls in the autoimmune category and usually begins with small patches of hair loss, but can become extensive to involve the entire scalp and even hair elsewhere on the body. It affects men, women and children and often runs in families.
How is alopecia diagnosed?
The different types of alopecia can be properly diagnosed by close visual inspection of the scalp, usually by a dermatologist. Rarely, a biopsy or other additional testing is required.
What causes alopecia?
There are many types of alopecia, and the causes and treatments differ significantly. Some types of alopecia are self-limited and correct themselves without any intervention at all. This is the case with chemotherapy induced hair loss and the hair shedding that occurs after pregnancy. Other types such as male or female pattern hair thinning can be more chronic and progressive, requiring life-long treatment to maintain the hair.
As I say to my patients several times a day, “the only thing predictable about alopecia areata is that it is unpredictable.” The hair may spontaneously grow back as mysteriously as it fell out or it may be more persistent requiring treatment with potential for waxing and waning bouts of shedding followed by regrowth.
How common is alopecia?
Alopecia is a very common condition seen by dermatologists every day.
What are the best treatments for alopecia? Does hair grow back from alopecia?
There is no single treatment for all the types of alopecia, which is why it is important to make an accurate diagnosis from the get-go to initiate proper treatment. Alopecia areata falls in the category of reversible hair loss, while other types of hair loss create scar tissue that can result in permanent hair loss requiring early intervention to save the remaining hair.
Dermatologist offer many hair loss treatments including pills, creams, injections, laser and light therapies and even hair transplants. Industry has responded vigorously to consumer demand for hair loss remedies with a myriad of expensive over-the-counter products, many of which are unsupported by rigorous scientific proof of efficacy. We are doing studies in our clinical trials unit on a new class of drugs for alopecia areata that combats the overactive immune cells attacking the hair.
What stigmas do those with alopecia face?
Alopecia tremendously impacts quality of life and emotional well-being because it is so visible. While both women and men are negatively impacted by the various forms of hair loss, women in particular equate their hair with youth and femininity, and its loss can have a devastating psychologic impact.