Diagnosis & Treatment
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Diagnosis of the autoimmune disease, alopecia is made by considering your symptoms with physical signs that a doctor can see. The most common symptom is circular areas of hair loss on the scalp or beard area.
There are other types of hair loss, which are not caused by an autoimmune condition; These include Androgenic Alopecia, Trichlomania Alopecia and more.
Hair loss for any person can be very frightening. In some cases hair loss can occur rapidly, which can be an extremely shocking experience.
It is important to take the necessary steps to address the hair loss
1. Make an appointment with your GP as soon as possible.
2. Your GP should take a detailed history of your hair loss and then the standard procedure is to refer you to see a dermatologist
3. The dermatologist should talk about your history of hair loss and examine you. They may take a skin biopsy from an affected area and a blood sample from a vein in your arm. When Autoimmune Alopecia is confirmed, your dermatologist should tell you more about the condition, discuss the different courses it can take, discuss the treatment options available and answer any questions that you may have.
4. It is important to address the psychological side of Autoimmune Alopecia. Often patients with Alopecia feel very let down by the medical system. No psychological support is given and patients can be sent home with no future support or advice, no cure and ultimately no hope for recovery in the future.
This disease is life changing and Autoimmune Alopecia can be very hard for people to come to terms with. Many feel emotions of grief for their hair, isolation, anxiety and depression. It is important to seek help from your doctor and look to the support of others who also suffer Autoimmune Alopecia to know that you are not alone.
There are no evidence based treatments 100% successful for autoimmune alopecia.
The success rate of the treatments available is relatively low but the low incidence of side effects means that they are worth trying under the guidance of a doctor.
The majority of treatments are not meant to be used forever. If a treatment does help hair to regrow, the course after the treatment is stopped is unpredictable; sometimes the hair remains and hair loss is never encountered again, sometimes hair loss can restart after a period of time and sometimes hair loss can reappear immediately after stopping a treatment.
80% of patients with limited patchy hair loss regrow the lost hair within one year and many have an acceptable level of regrowth within 6 months. For many people with a limited amount of hair loss a dermatologist may suggest not having any treatment initially. If hair loss is extensive and has been long standing then it is not unusual to not be using any pharmacological treatments.
Injections of steroids directly into hairless areas on the scalp and beard can effectively stop further hair loss and promote hair regrowth in people with early onset Alopecia Areata. These injections dampen the local immune response. These can be successful as a first treatment for AA if the area affected is localised to one or a few small patches. It can take 4-6 weeks for new hair growth to become visible and after one or two months the injections are reduced until stopped. Unfortunately only a minority of sufferers benefit from these injections and hair loss can return when the treatment stops. The doses of cortisone are small and this reduces the likelihood of side effects that are encountered when steroids are given orally. The injections can be painful and the most common side effect is swelling and local pigmentation.
Oral steroids can be used for wide spread cases of patchy hair loss. They are only used by dermatologists for a set period of time and there are higher incidences of side effects. Hair loss can return after treatment is stopped.
Steroids can be delivered as a cream or ointment and applied to the effected and surrounding areas. They are thought to be less effective than injections and, like all Autoimmune Alopecia treatments, do not have a high success rate.
Anthralin / Dithranol
This tar-like substance is thought to dampen the immune response in tissue that is applied to and has been used for the treatment of alopecia. It is applied for 20 to 60 minutes on the affected areas and can take 8 to 12 weeks to show results. The treatment can stain skin and clothes and the success rate is not high so it is infrequently used.
This treatment uses an irritant to cause a local immune response that is thought to interfere with the already ongoing response that is occurring with Autoimmune Alopecia. The treatment is carried out over a 6 month period by a dermatologist and can cause a degree of hair regrowth in 50% of patients. Success rates are higher when hair loss is limited to smaller areas and there is still a risk of hair loss after the treatment has stopped.
This treatment combines the use of UVA light and a drug called psolralen to promote hair regrowth. Some trials suggest that the treatment is effective but often the treatment must be carried out multiple times per week. Hair loss can often occur when the treatment is stopped and the cumulative risk of UVA exposure increases the risk of skin cancer.
Minoxidil is a topical treatment that is used to promote hair growth and is more commonly used for male pattern hair loss. Studies have shown that it is rarely effective in the treatment of Autoimmune Alopecia.
With all of these treatments it is important to make sure that you understand the risks & their success rates. Your doctor should be able to answer all of your concerns and provide up to date advice.