Alopecia areata (hair loss)

Alopecia means hair loss. Alopecia is a common disorder. It usually happens on the scalp. But, in severe forms, it can also involve hair all over the body.

It affects about 1.7% of people by the age of 50.

Three forms of alopecia

The form of alopecia depends on how much hair is lost.

• Alopecia areata: This is the most common type. People with alopecia areata have round, well-defined patches of hair loss.
• Alopecia totalis: Loss of all hair on the scalp.
• Alopecia universalis: Loss of all scalp and body hair.

Causes of alopecia areata

Skin cross section

The course for alopecia areata changes from patient to patient. It is hard to predict exactly what will happen in your child's case.

We do not know exactly what causes alopecia areata. But it seems to be the result of an auto-immune process. This means that the immune system attacks the hair follicles by mistake. The follicle is the pocket at the base of the skin that grows and holds the hair. When it is attacked, it lets go of the hair. The damage does not last forever. The follicle can still work and grow hair.

How alopecia areata is diagnosed

Your child's doctor will diagnose alopecia areata by examining your child and talking to your family. Testing is usually not needed to diagnose alopecia areata.

With alopecia areata, the immune system may also attack other organs, such as the thyroid and adrenal glands. So, your child's doctor will order some tests to see if they have been damaged.

Medical treatment for alopecia areata

Your doctor may decide not to give your child any treatment for alopecia areata at first. Sometimes the hair can grow back by itself. A "wait and see" approach may be the best option.

Most smaller, single patches of alopecia have a good chance to grow again with treatment. New patches may develop over a period of weeks to months. Even with good response to treatment, though, the hair may fall out again after a period of re-growth at first.

Other treatments may help treat the bald patches that exist but cannot prevent new ones from forming. Some of these treatments include:

• Steroid cream on the bald patches
• Corticosteroid injections between the layers of the skin. These are also called intradermal injections. They help suppress the immune system. This works to stop the body from attacking the hair follicles. They also reduce swelling.
• Contact sensitizers are drugs that lead to an allergic reaction. This leads to hair growth. This drug is often diphenylcyclopropenone (diphencyprone) or DPCP.

Alopecia universalis does not respond as well to medical treatment.

Supporting your child with alopecia areata

These are some of the things you can do to help your child cope.

• Educate your child about alopecia areata. Be honest and open and support your child. Knowledge is power and comfort.
• Discuss the situation with your child's principal and teacher. If they know what your child has, they will be more likely to support your child. Give your child the option of informing classmates.
• Model good problem-solving and ways to cope. This means that it is all right to show and share your feelings. It is important that you address the feelings of both you and your child. If you and your child have a hard time coping and it affects your everyday life, you may want to consider speaking with a counselor.
• Listen to your child. It is important that your child has someone that they trust and talk to. The person can be a family member, friend or a counselor.
• Encourage your child to pursue things they love and guide them towards activities that will help them feel good about themselves. Provide your child with positive messages and praise. Your words have a great impact on how your child feels about themself. Self-esteem is crucial.
• Give your child the choice to interact with other children who have alopecia areata. This will allow them to share their experiences and know they are not alone.
• Another way to cope with the disease is to minimize its effect on your child's appearance. Your child may want to wear a wig or bandana.

Look Good Feel Better Centre

Princess Margaret Hospital

3-642, 610 University Avenue

Toronto, ON M5G 2M9

Contact: Zain, wig specialist/coordinator

Telephone: 416-946-6596 and 416-946-2075

Fax: 416-946-2077

E-mail: wig.salon@uhn.on.ca

Alopecia resources

DermNet NZ: The dermatology resource

Locks of love

National Alopecia Areata Foundation