What is Alopecia Areata?

Alopecia Areata (or spot baldness) is a form of inflammatory hair loss. Although it has been known for a long time, it has remained largely unexplored, even though more than 1.5 million people of the German population are affected by this disease in its various forms.

Typical symptoms for Alopecia Areata are circular patches of baldness where hair falls out, which is why this disease is also called “spot baldness”. In 80% of all cases hair loss occurs in the head area, but may also occur in the beard area and in exceptional cases other areas of body hair growth are affected. These bald surfaces often do not contain any hair at all and the patches tend to spread further from the center. For most patients, only a few bald spots develop, and these sometimes disappear spontaneously as hair starts growing again without treatment.

In the case of Alopecia Totalis, a person loses all hair on his head, and in the case of Alopecia Universalis, all areas of body hair growth are affected. These forms of the disease are (fortunately) rare.

Cause and diagnosis of Alopecia Areata (AA)

Experts assume that AA is an immune system disorder. It is certain that the patches of hair loss are surrounded by inflamed cells secreting substances which hinder or inhibit hair growth.

In Bonn, human geneticists work on the decoding of the genetic basis of this disease, which has a certain hereditary component. In addition to the HLA type, several potentially involved genes have also been targeted, which also play a role in the development of other autoimmune diseases such as type 1 diabetes and rheumatism. In the meantime, several scientists have started collaborating internationally on this subject, since in-depth research is possible only with a very large DNA databank of the affected persons, in order to find a solution to the problem.

The recent GWAS (genome-wide association study) has come up with ground-breaking new findings on human genome localizations, where gene changes leading to the onset of Alopecia Areata can take place. Further analysis and detailed investigation of the GWAS results will be conducted in Bonn by an international group of scientists including geneticists in the near future. There are other scientific communities researching the possible triggering factors for Alopecia Areata. It is suspected that there are at least four or five factors that must be combined in order for the antibodies to form. To date, no breakthrough results have been published. The assumption is that the immune system must operate at full blast, so to say, to form these “false” antibodies.

Diagnosis

This disease has already been described by Hippocrates. It was called ‘fox scabies’ or ‘fox disease’ at that time, because a fox’s coat usually has a patchy appearance. The disease is therefore not caused by environmental pollution. There are also no indications that hormonal disorders might be the triggering factors, since this disease affects people of different age and sex.

In children, Alopecia Areata occurs mainly between the ages of 3-12. However, before a specific treatment can be started, the Alopecia Areata must be confirmed. Other diseases such as Tinea Capitis, a fungus-induced infection of scalp skin, as well as cases of conscious or unconscious hair pulling (Trichotillomania) or hair cropping (Trichotomnomania) by patients themselves can be quite similar to spot baldness. In the latter case, the major cause is patient’s psychological tension, which can be detected in intensive discussions with children affected by this condition.

Are there any healing options?

Although Alopecia Areata is known worldwide and enormous efforts are made to investigate its causes, no therapy has yet been found to actually cure the disease.

There are only symptom therapies, which can sometimes lead to complete hair regrowth and recovery. However, none of those can guarantee that under certain conditions a patient’s hair will not fall out again. Rehabilitation and recurrence periods between hair regrowth and further hair loss may last anywhere between half a year and 30 years, because each case is quite different. There are various therapies helping overcome the major consequences of Alopecia Areata, i.e. hair loss, all following very different approaches. They either weaken the immune system so much that it can no longer ‘eject’ its own hair, or they try to modify the patient’s immune system, so that it will automatically shut down the hair loss mechanism.

Another option is the deflection system. The immune system is deflected by a “slight” injury to the scalp (slight redness and scaling) caused by various tinctures. While the antibodies are busy repairing the scalp, hair roots can regenerate. Most of the therapies achieve the desired result of hair regrowth in 70% to 75% of cases. At the same time, the spontaneous healing rate also lies between 75% and 80%, so for this reason, all therapies are viewed with a degree of controversy.

No therapy without side effects

Many dermatologists therefore advise the patient to wait. For many patients this recommendation is too difficult to understand and even more difficult to follow. Especially if children are affected, it is difficult for the parents to just sit and wait, watching their children lose more and more hair. However, this approach may well lead to self-healing, which would otherwise be suppressed. It was observed in various patients that the disease healed completely or even without therapy. It is also necessary to add that immunosuppressants (medications which reduce the function of the immune system) are not an option in the current form of treatment, in our opinion. Having discussed the matter with the manufacturers of these drugs, we were told that this type of medicine is not suitable for AA, from the manufacturers’ point of view. Other medical professionals believe that early treatment is helpful.

In long-term studies devoted to AA, no causes for the disease have been found. One study claims that after the therapy has been discontinued, hair loss is very likely. Therefore, the most important criteria for selecting the suitable treatment are, in particular, the age of the children, the duration and the severity of the disease as well as the possibility that one of the above-mentioned diseases may be also present. In addition, the children’s social environment must also be taken into account, i.e. family relations and the situation at kindergarten or school. Generally speaking, the biggest prospects for successful healing can be expected if the affected area is small, if the disease started after puberty, if it lasted less than one year, and if no other diseases are registered. Thus, treatment is more difficult to classify in pronounced, rapidly progressing cases, starting at pre-puberty age, lasting for more than one year, and combined with some additional auto-immune disorders.

In acute cases, which have developed only recently and are now progressing, or if the case is only a mild one, we should first look for inflammation centers in the patient’s body, which cannot be considered as a fundamental cause, but as a causative factor. If, for example, a chronic almond or nasal sinus infection is found, these should be treated, even if this does not necessarily lead to the regrowth of the hairless areas. In the treatment of AA, the dermatologist is the first person to consult, in order to make the right diagnosis. Further on, attending a specialized dermatological clinic may be necessary, since not all forms of therapy can be carried out in the surgery of a practicing physician or family doctor. It is also advisable to work in collaboration with a pediatrician, who is an expert on treating young patients and children, as he might help, for example, in the search for inflammation centers.

Therapy approaches – Alopecia Areata

Let us be honest: we must soberly admit that unfortunately there is currently no cure for Alopecia Areata. And so the existing therapy approaches are of two types: either they produce some effect as long as the therapy continues (if there is any real effect at all), or they are of rather questionable nature … or even both. Especially since most therapies are not approved for affected children under 16 years of age.

Are there any healing options?

Although the disease is known worldwide and enormous efforts are being made to investigate its causes, no therapy has yet been found which could actually cure the disease. There are symptom therapies, which may lead to partial or even complete rehabilitation. However, after the therapy has been discontinued, cases of recurring hair loss are very frequent. Many dermatologists therefore advise their patients to wait. For many affected persons such approach seems incomprehensible and difficult to carry out. Especially when children are affected by AA it is difficult for the parents to just wait and watch the hair loss continue without doing anything about it. However, waiting may indeed lead to self-healing, which would otherwise be suppressed. After all, the spontaneous healing rate (that is, renewed hair growth without prior therapy) is 75-80% – which is the same as that of currently known therapy approaches! For this reason, the significance and the effect of all therapies are viewed with a degree of controversy.

PLEASE NOTE: This information cannot replace a personal appointment or consultation with your doctor!

Cortisone (glucocorticoids)

There is scarcely any need to introduce cortisone, the most well-known drug therapy for Alopecia Areata. Often in the case of small inflammation areas affected by spot baldness, often at the onset of the disease, cortisone-containing drugs are used in the form of solutions or creams. The effect of externally applied glucocorticoid preparations is however very limited in case of Alopecia Areata, because of the drug’s limited skin penetration depth. In addition, there are also cortisone injections into the scalp, as well as intravenous infusion (Pulse therapy). Still, as with most treatments for Alopecia Areata, it is difficult to predict or influence the long-term course of the disease, even with temporary cortisone therapy.

Topical immunotherapy (e.g. DCP)

Topical immunotherapy consists in the repeated application of a special contact allergen to the patient’s head. This creates and maintains an allergic contact eczema. As a result of such scalp treatment, new hair growth is stimulated. Presently neither of the two substances are contained in any approved medicines which makes the cost of such treatment quite expensive. Therefore, in general, this method should only be used in the case of extensive and severe forms of Alopecia Areata, but not for children, due to formal legal requirements connected with these medicines. The approved age limits may vary at different medical centers.

Zinc therapy

Zinc therapy is based on the recognition that Alopecia Areata is a disorder of the immune system. Due to the “misinformation” of the immune system the organism tries to destroy the hair root by means of inflammation. Zinc administered into the patient’s body acts as an immunostimulator ensuring that complicated biochemical reactions compensate for cell imbalance in the immune system, which appears to be associated with the cases of occurring “misinformation”. The efficacy of this therapy is also not confirmed.
The advantage of this therapy approach is that it is also available to children, since it obviously does not have any significant side effects.

Thymuskin®

Thymus peptides, as used in Thymuskin®, stimulate the cells of the immune system to differentiate and multiply. This stimulation liberates the cells’ messenger substances that modulate the entire network of the immune system. Based on experience from its application monitoring at several skin clinics and university clinics, Thymuskin® was also used in patients with Alopecia Totalis and Universalis. In 65% of cases, visible hair growth occurred in the head are and / or body after 9 to 12 months (with daily use of Thymuskin® as hair shampoo). The efficacy of this therapy approach therefore does not exceed the spontaneous healing rate and unfortunately cannot be considered reliable. However, no side effects were observed at all.

You can find more information about the individual therapy approaches in our brochure, which you can request from us.