Without a Trace: Non-scarring Alopecia

Non-scarring hair loss disorders are generally reversible, but that
doesn’t mean that you shouldn’t take them seriously. Here, we
describe some of the most common causes of non-scarring hair
loss, their symptoms, and their treatments.
Seeing circular bald spots:
Alopecia areata
As if there aren’t already enough difficult-to-pronounce terms in
this book, here’s another one: alopecia areata. Also called AA,
alopecia areata is an autoimmune disease that causes hair loss
(see the sidebar “What’s an autoimmune disease?”). AA is some-
times called spot baldness because it causes round spots of hair
loss. The disease, which is relatively common, tends to run in fami-
lies and affects about 1 to 2 percent of the population in the United
States. In about 2 percent of patients, the disease changes into a
more diffuse form of hair loss, covering wider areas of the scalp.
Alopecia areata occurs when a person’s white blood cells attack
and destroy the body’s hair follicles. After hair follicles are
attacked, they stop producing hair, causing the distinctive local-
ized bald patches that are the mark of alopecia areata. The hair
loss usually occurs over a short period of time.
Severe alopecia areata can take two forms:
 Alopecia totalis: All hair on the scalp is lost.
 Alopecia universalis: All hair on the scalp is lost, along with
hair on the eyebrows, eyelashes, and all other parts of the
body.
Less severe alopecia areata can take these forms:
 Alopecia areata monolocularis: Baldness occurs in only one
place on the scalp.
 Alopecia areata barbae: Hair loss occurs in patches in a
man’s beard.
AA can occur at any age, with most patients diagnosed between
the ages of 15 and 29 and nearly half being under age 20. An equal
number of men and women develop AA, and the disease occurs
equally in every race.
Diagnosing the disorder
Alopecia areata doesn’t follow a predictable path. Some patients
feel burning or itching in the area of balding, but others don’t.
Eighty percent of patients have only one bald spot. The bald
patches can be round or oval in shape, and expose smooth, bald
skin.
The disease normally affects only the scalp, but other body hair
also can be affected and aid in diagnosing the condition.
Interestingly, if you have fingernail abnormalities such as small pits
on the nail plate, you may also have alopecia areata. Atopic der-
matitis (an allergic skin condition) and vitiligo, a disease that
causes white patches on the skin, are also more common in people
with AA.
An important diagnostic clue to alopecia areata is the presence of
“exclamation point hairs” on the perimeter of the bald patch.
These hairs form as the body attacks the lower portion of the hair
follicle, and the damage produces a finely tapered end. As the hair
continues to grow, it looks like a tiny spear stuck in the scalp.
Eventually this hair will be lost, but its presence is a sign of alope-
cia areata in its active stage.
Your doctor may gently pull hair along the edge of a bald patch to
determine whether you have alopecia areata. Healthy hair doesn’t
come out when pulled gently, but hair afflicted with alopecia areata
is easily removed.
Exploring treatment options
If you’re diagnosed with alopecia areata, the good news is that in
90 percent of cases, hair grows back on its own and no treatment is
needed. The chances of regrowth are best when the condition is
localized to just a few places on the scalp and the patient is over
age 40. In younger patients, unfortunately, the condition tends to
be more severe. If the disease progresses to alopecia totalis or
alopecia universalis (refer to the earlier section, “Seeing circular
bald spots: Alopecia areata”), no surefire treatment is available.
Options for treatment include:
 Steroids: One of the main functions of steroids is to reduce
inflammation, but in patients with AA, steroids are used to
stop the body’s immune cells from destroying hair follicles.
Your doctor may inject steroids directly into your bald
patches or may prescribe a topical steroid cream that you can
apply to the bald patches at home.
When the disease is too extensive to treat with multiple injec-
tions or topical creams, oral steroids are an option. Usually,
you only take them for a short period of time because of the
many side effects of long-term use, including osteoporosis,
very fragile skin, and diabetes.
 Minoxidil: This medicine works because hair growth is a side
effect of the drug that may directly affect bald spots. You
apply it directly to the bald patches. Minoxidil is commonly
used to treat pattern baldness, but for unknown reasons it
also sometimes helps patients with AA.
 Cyclosporine: This potent immunosuppressant specifically
inhibits T cells, the immune system cells that attack hair folli-
cles in AA. Cyclosporine is most often given orally. It’s more
commonly used to treat other conditions such as psoriasis,
and many physicians are hesitant to use it medicine to treat
AA because it can cause kidney damage, high blood pressure,
and suppress your body’s immune system.
 DNCB: This chemical (full name dinitrochioro benzene) rapidly
produces skin sensitivity. In some people with severe alopecia
areata, continued application of DNCB (enough to produce a
continuing rash caused by the activation of white blood cells
to boost the local immune function). This caused hair
regrowth in some individuals. It doesn’t always work, how-
ever. You should take DNCB only under the strict supervision
of a doctor who’s experienced with this treatment.