Superman was bald? Alopecia Areata, or hair loss, can affect even the brave and beautiful...
Who would have thought that Superman was going bald? But, it’s true. Christopher Reeve, who played the iconic superhero, was a master at cleverly hiding his thinning patches by combing it over with his other hair. Would he have seemed less attractive if we saw those balding spots? Less heroic? Less brave? Would the singer Tina Turner, with those long iconic legs, seem less appealing if we knew she wore wigs to hide her hair loss? It might surprise you to hear these names mentioned in conjunction with baldness. Fact is, these stars both suffered from alopecia, a medical condition that causes thinning or balding patches of hair on the scalp, face and even throughout their body. Not everyone has the same degree of hair loss, but it is a condition that can be devastating to the psyche, especially in women. And the reason why people don’t openly admit they suffer from the condition is often because they fear humiliation, embarrassment or they want to avoid ridicule.
What is Alopecia?
Alopecia (al-oh-PEE-shah) means hair loss. When a person has a medical condition called alopecia areata (ar-ee-AH-tah), the hair falls out in round patches. The hair can fall out on the scalp and elsewhere on the body. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis), which can include loss of eyebrows, eyelashes, facial hair in men and even loss of pubic hair.
Not everyone loses all of the hair on the scalp or body. This happens to about 5 percent of people.
The scalp, however, is the most commonly affected area, but the beard or any hair-bearing site can be affected. Hair often grows back, but may fall out again. Sometimes, the hair loss lasts for many years. Unfortunately, Alopecia areata is a highly unpredictable and cyclical condition. It occurs in males and females of all ages, but onset often occurs in childhood, and over 6.6 million people in the United States and 147 million worldwide have or will develop alopecia areata at some point in their lives.
What Causes it?
The important thing to remember is that Alopecia is not contagious and it is not due to nerves. It is basically an autoimmune disease where the person’s own immune system attacks the hair follicles. The affected follicles then become very small and produce no visible hair above the skin’s surface.
Researchers aren’t sure why the hair loss occurs. They suspect that Alopecia is similar to other autoimmune diseases, such as rheumatoid arthritis. However, in the case of Alopecia, the individual's own immune system attacks hair follicles instead of bone joints. Just why or how the condition develops is not clear. For whatever reason, the immune system is inappropriately activated and attacks hair follicles, mistakenly thinking that somehow they are a threat to the rest of the body. We do not know what activates the autoimmune reaction, but it seems to be a combination of genetic susceptibility and environmental triggers outside the body, such as bacteria or viruses, which may signal changes that confuse the immune system.
Unfortunately, children who develop Alopecia before puberty are most likely to develop more extensive and persistent hair loss. The good news is, no matter how widespread the hair loss, most hair follicles remain alive and intact. They can resume normal hair production whenever they receive the appropriate signal. That’s why hair regrowth can occur even without treatment and even after many years.
What are the Symptoms?
People can have this type of hair loss at any age, but it often begins in childhood.
Symptoms vary, but you may experience the following:
- Patchy hair loss: The problem often begins with coin-sized, round, bare patches where hair once was. You may first notice the problem when you see clumps of hair on your pillow or in the shower. Hair loss occurs mostly on the scalp. But it can involve eyebrows, eyelashes, beards or any hair-bearing site.
- “Exclamation mark” hairs: Often, a few short hairs occur in or at the edges of the bare spots. These hairs get narrower at the bottom, like an exclamation mark.
- Widespread hair loss: With time, some patients go completely bald. Some lose all their body hair as well, but this is not common.
- Nail problems: Alopecia areata can also affect your fingernails and toenails. Nails can have tiny pinpoint dents or ‘pitting’. They also can have white spots or lines, be rough, lose their shine, or become thin and split. Nails rarely change shape or fall off, but nail changes can bethe first sign of the disease.
Luckily, where the hair loss occurs, there is often no redness and no pain, although a few people do find their skin itchy or painful to touch in the very early stages of the disease. Usually, though, there is no sensation, just a patchy shedding of hair.
The hair loss can be quite sudden, developing in a matter of days and it may happen anywhere on the scalp. People with just one or two patches of hair loss often have a full and spontaneous recovery within two years, whether or not they receive treatment. However, about 30% of individuals find the condition persists and becomes more extensive, or they have repeated cycles of hair loss and re-growth.
How is it diagnosed?
Sometimes a dermatologist can diagnose alopecia areata by looking at the hair loss. If the patch of hair loss is expanding, the doctor may pull out a few hairs and will study them under a microscope. The dermatologist may perform a skin biopsy to confirm that the disease is alopecia areata. To perform a skin biopsy, the dermatologist removes a small piece of skin so that it can be studied under a microscope. Blood tests may also be necessary, if the dermatologist thinks the patient might have another autoimmune disease.
What Treatments are Available?
There is no cure for alopecia areata, but treatment can help the hair re-grow more quickly. Before starting any course of treatment, it is important to see your doctor or dermatologist, as some of these medicines could have serious side effects.
Some treatments a dermatologist may prescribe:
- Corticosteroids: This treatment is often the first one tried because corticosteroids suppress the immune system which attacks hair follicles. Injections are usually given by a dermatologist. They use a tiny needle to give multiple injections into the skin in and around the bare patches. The injections are then repeated once a month.Hairgrowth begins after about 4 weeks. Sometimes, it takes longer. Patients can also be prescribed a topical ointment or cream which is applied to the skin. Less often, patients are given corticosteroid pills, but regrown hair is likely to fall out when the cortisone pills are stopped.
- Minoxidil: This is a hair re-growth medicine. Minoxidil 5% is the most effective. It may help some patients re-grow their hair. Both children and adults can use it. Scalp, eyebrows, and beards may also re-grow with this medicine.New hair may start to grow in about 3 months. Patients most often use this medicine with another treatment. However, the solution is not as effective in treating those with 100% scalp hair loss.
- Anthralin: Anthralin is a synthetic, tar-like substance that has been used widely for psoriasis, but it also works to alter the skin’s immune function. The patient applies a tar-like substance to the skin and leaves it on for 20 to 60 minutes. The anthralin is then washed off to avoid skin irritation.Care must be taken not to get it in the eyes and hands must be washed after applying it.
- Topical Immunotherapy: Another method of treating extensive alopecia areata involves producing an allergic rash or allergic contact dermatitis. Chemicals such as diphencyprone (DPCP) are applied to the scalp to produce an allergic rash which resembles poison oak or ivy.Dermatologists believe this allergic reaction tricks the immune system, causing it to send white blood cells to the surface of the scalp. This fights inflammation and also prevents the hair follicles from going to sleep and causing hair loss.Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment.
Psychological Impact of Hair Loss:
Alopecia areata is a condition that does not discriminate. It can occur at any age, and affects males and females equally. Unfortunately, Alopecia areata often starts in childhood and can be distressing to children who are often teased for being ‘different’ or ‘strange’. Children may be concerned about how others view them, how they may differ from others, and whether others might be making fun of them.
Grown men and women may also suddenly develop this disease and have their own set of issues surrounding hair loss. Though the bald look on men has become acceptable, if not desirable, adapting to a diagnosis of alopecia areata can still be extremely difficult for many men. And for women, it can be a drastic life change. Sudden changes in appearance can bring on a whole host of insecurities.
People with Alopecia areata may feel:
- Alone, withdrawn, and isolated
- Loss and grief
- Sadness and depression
- Guilt or self-blame that you somehow brought the disease on yourself
- Guilt related to how the disease is affecting family members and loved ones
- Frantic in regard to searching for an answer or cure (going to extremes)
Sadly, people with this disease often have high levels of anxiety and depression and the failure to find a cure can leave patients very distressed. Patients also report feelings of lower self -esteem, they may have a poorer quality of life, and often suffer from a poor body image. Those who lose eyebrows and eyelashes may also have problems with identity and identity change,as these features help to define a person's face.
Ways to Cope:
Unfortunately, people with more extensive, long-term Alopecia do not find relief with the treatments currently available. For these individuals, the only practical answer is cosmetic fixes such as wigs, as well as plenty of emotional support.
Wigs: We all know that hair is essential to the identity of many women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Hair loss can therefore seriously affect self-esteem and body image. Wigs or hair pieces are often the primary way to disguise hair loss. They are most often used by women, but men also find them an attractive option. Proper attention will make a quality wig look completely natural if it is cut, thinned and styled properly.
If you are looking for a wig or hair piece, our friends at Pacific Hair invite you to come in for a free consultation. Depending on the extent and positioning of the alopecia on the scalp, clients may opt for either a human hair piece or a human hair lace front wig for full coverage (for alopecia totalis). Their best suggestion? "Do your research before you come in," says Fanta, who works with clients who have Alopecia areata. "Most Alopecia sufferers immediately assume they'll need a wig, which isn't always the case. Some will only need partial hair pieces. That's why, at the consultation, we will conduct head measurements and determine the length, texture and colour that will best suit your needs. Our main goal is to make sure you have something that is comfortable and incredibly natural looking. And we can have a hair system ready for installation within 2 weeks."
Eyebrow loss: If someone has extensive hair loss throughout the body, especially the face, it could be distressing to find your most expressive features, such as your eyebrows and lashes, fading away. Some women use makeup to draw on their missing eyebrows, but this can often look unnatural and can take some time to achieve a decent look. Some women have instead opted to get their eyebrows permanently tattooed, or what is called micro pigmentation. With a qualified artist, these brows are tattooed on to the skin using light, feathery strokes that mimic individual hair strands. The results are often more natural looking than a solid line of pencil drawn above the eye. For more info on permanent makeup, or to make an appointment for a free consultation with one of our artists, click here.
Skin: Thankfully, the primary symptoms of the disease don't include rashes, hives or itching. However, the exposed skin needs to be cared for just the same. In alopecia areata, the body is without hair in many, if not all, locations. It is therefore essential to apply a moisturizing lotion, to prevent unnecessary drying (we recommend PCA’s clinically-formulated Collagen Hydrator, $52.00, which provides rich emollients and alleviates skin dryness, or PCA’s Silkcoat Balm, $52.00, which balances the skin’s natural moisturising factor). A high SPF sunscreen is also recommended, to prevent exposure to unhealthy rays.
Emotional toll: The emotional aspects of living with hair loss can be difficult. Society regards hair as a sign of youth and good health. The good news is that alopecia areata does not affect someone’s overall health. It should not stop you from achieving your goals and dreams and it is no reason to exclude yourself from school, sports or work. If your hair loss bothers you, though, you may wish to join a support group. To find local groups in your area, contact the Canadian Alopecia Areata Foundation, or CANAAF, at http://canaaf.org/get-in-touch/. Or visit their support page at: http://canaaf.org/alopecia-support-groups/
Sources: (Images, from Top to Bottom: All images via Flickr Creative Commons, except for Before & After eyebrow pics courtesy of Elan Beauty: Nicholas Rumas, arianne leishman, Carolyn Speranza, Medisave UK, arianne leishman, Mike Mozart, CANAAF website)
- Alopecia Areata By the American Academy of Dermatology; URL: https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/alopecia-areata
- The National Alopecia Areata Foundation; URL: https://www.naaf.org/alopecia-areata
- The Canadian Alopecia Areata Foundation; URL: http://canaaf.org/
- Alopecia Areata By WebMD; URL: http://www.webmd.com/skin-problems-and-treatments/hair-loss/hair-loss-alopecia
- The psychological impact of Alopecia By Nigel Hunt; US National Library of Medicine; URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1261195/
- Celebrities with Alopecia: stars battle hair loss By the Healing Alopecia Center; URL: http://www.healingalopeciaareata.com/celebrities-with-alopecia-stars-battle-hair-loss/