Update on Alopecia

What is alopecia?

Alopecia is also known as baldness or loss of hair from the head or body.

On the scalp, it may manifest as rapid shedding or gradual thinning of the hair. It could present as a patch or a more diffuse pattern.

When facial hair is involved, it is called madarosis.

Sometimes, there could be other related symptoms with scalp alopecia such as redness, presence of scale, itchiness or pain.

What causes alopecia?

There are many causes of alopecia, which are broadly classified as scarring and non-scarring alopecia.

The common causes of alopecia as a whole are androgenetic alopecia (a combination of genetic and hormonal factors), telogen effluvium (a form of stress-induced alopecia) and alopecia areata (autoimmune process). While most of these are less aggressive or self-limiting, scarring alopecia tends to be more aggressive and irreversible.

Therefore, it is very important to get help early to stop the disease process and recover as much hair as possible. It is also possible to have several coexisting scalp conditions which often makes the diagnosis less straightforward and this can cause a delay in treatment.

During a consultation, your physician will take a detailed medical history and carry out a thorough scalp examination to establish the likely cause of your scalp complaint.

When the diagnosis is less straightforward, it is necessary to carry out a scalp biopsy for histopathology and other ancillary tests. The biopsy entails having a minor procedure carried out under local anaesthesia that could be done safely as a day procedure.

Following these steps, it enables your physician to have a detailed discussion with you on the diagnosis, anticipated treatment response and potential adverse effects of treatments. While you are on treatment, regular reviews will be arranged to monitor your progress.

Treatment of alopecia

Depending on the type of alopecia, possible treatment options range from oral medication, topical treatment or a combination of these. Sometimes, screening and correcting certain medical conditions, optimising certain nutrients and modifying personal grooming methods can facilitate hair regrowth when done in conjunction with the primary treatment.

The treatment landscape for alopecia has widened in the last few years. One of the newest treatments is the Janus kinase (JAK) inhibitors. It works reasonably well when used for alopecia areata.

However, similar to all new systemic medications for alopecia, there are several questions regarding the JAK inhibitors: Can it be used topically to limit its systemic toxicity?  Is the oral or topical form affordable? What are the potential adverse effects for long‐term treatment?

If treatment response is good, what would happen once it is stopped? Given its non-specific action in inhibiting signalling pathways, it has a potential to cause a broad range of adverse effects. While waiting for a more robust risk : benefit ratio to be established, patients should explore other conventional treatment options (those that potentially have reasonable treatment response and safety profile) with their physicians.

Fortunately most causes of hair loss can be stopped or treated. It is important to note that despite good treatment, successful hair regrowth could take several months to occur. Therefore, until results are achieved (as per the initial agreed plan with the physician), it is integral for patients to remain motivated and not to be discouraged with the treatment regimen recommended.  Finally, people who have alopecia are highly recommended to seek medical advice from a board certified specialist.

Aizuri Murad, MBBS, MRCS, MRCP (UK) is a Consultant Dermatologist & Derm Surgeon at the Mater Misericordiae University Hospital, Dublin, Ireland

If you need guidance or support about managing a skin disorder, contact the ISF Helpline for free assistance and information.