Understanding Alopecia

Alopecia is an autoimmune disorder that causes excessive hair loss without any prominent reason. It primarily affects the scalp but can also affect eyebrows, eyelashes, the face, or other body parts.

Alopecia areata is a common condition that affects nearly 147 million people worldwide. In the US, It affects almost 6.8 million people, with a lifetime risk of 2.1%, according to the National Alopecia Areata Foundation.

Understanding Alopecia

What is Alopecia?

Alopecia is a condition in which the body’s immune system attacks its own hair follicles resulting in rapid hair loss. Alopecia areata begins with small bald patches but can affect wider areas on the scalp.

In many cases of Alopecia, hair regrows after a while; however, it can fall again. Alopecia can affect any person regardless of gender, ethnicity, age, or race and can develop in adulthood or childhood. It mostly develops in people before age 30 and is different for everyone.

Causes of Alopecia

In Alopecia, the white blood cells attack the cells in the hair follicles resulting in hair loss. The exact cause of Alopecia is unknown as it can affect an otherwise healthy-looking individual.

Scientists are unable to find the root cause of why the immune system behaves this way and attacks the hair follicles. They attribute multiple factors which lead to Alopecia. However, it is observed that Alopecia occurs due to genetics. Almost one in every five people who develop Alopecia has a family member diagnosed with the condition.

Many scientific researches have shown that people who have a family history of Alopecia have a family history of many other autoimmune disorders such as atopy, thyroiditis, and vitiligo. People with Down’s syndrome also experience Alopecia.

Alopecia is not hereditary as it is a polygenic disease meaning that both parents need to contribute a significant number of genes to make it appear in the progeny. As a result, parents don’t pass Alopecia to their children. In the case of identical twins, if one has it, there is a 55% chance that the other twin would also develop it.

Many people assume that Alopecia results due to stress; however, that is not true as there is minimal scientific data to support the cause. Some cases of extreme stress may lead to hair fall, but many researchers conclude genetics to be the primary reason for Alopecia.

Risk Factors of Alopecia

While Alopecia is an autoimmune disorder, hair loss may occur due to many significant factors such as:

Aging: Hair loss mostly occurs due to aging, especially characterized by male-pattern and female-pattern baldness. This hair loss is called androgenic alopecia. It is a gradual process of hair fall resulting in a receding hairline in men and thinning hair in the crown of women’s scalp.

Hormonal Changes: Hair loss may also occur due to hormonal changes as a result of pregnancy, childbirth, or menopause.

Medical Conditions: Alopecia areata is a leading cause of hair loss. Scalp infections such as Ringworm and Trichotillomania, an obsessive hair-pulling disorder, also causes temporary or permanent hair loss.

Medications: Certain drugs and medications used to treat cancer, arthritis, heart problems, gout, high blood pressure and depression also cause hair loss.

Stress: Some people experience hair thinning a few months after a shocking or stressful incident.

Hairstyles: Pulling your hair tight and making certain hairstyles such as cornrows or pigtails can cause traction alopecia, hair loss associated with excessive hair pulling due to hairstyling. Using heating tools or hot oil excessively can also lead to hair loss.

Nutrition: Poor nutrition, vitamin D deficiency, and rapid weight loss also cause hair loss.

Types of Alopecia

Alopecia is not just limited to the scalp. It can affect many body parts such as the chest, eyebrows, eyelashes, beard, arms, or legs. There are different types of Alopecia, such as:

• Patchy Alopecia areata

Coin-sized bald patches appear on the scalp, which may affect other body parts too. The patches may regrow after some time.

• Persistent Alopecia areata

Persistent alopecia areata refers to hair loss that remains localized and does not progress to alopecia totalis or alopecia universalis. In this form, individuals experience patchy hair loss without it advancing to complete scalp or body hair loss. Alopecia areata is an autoimmune condition where the immune system attacks hair follicles, leading to hair loss.

• Alopecia totalis

If Alopecia causes complete hair loss on the entire scalp, this condition is known as Alopecia totalis.

• Alopecia universalis

If hair loss is observed in the entire body, this condition is known as Alopecia universalis.

• Diffuse alopecia areata

This type of Alopecia resembles male-pattern or female-pattern baldness and results in extensive hair thinning all over the scalp.

• Ophiasis alopecia

If hair loss occurs on the sides and the lower back of the scalp, then this is known as Ophiasis alopecia.

Symptoms of Alopecia

The most noticeable symptoms of Alopecia are the development of quarter-sized bald patches (Alopecia areata) on the scalp and hair loss. They can also form on the beard, eyebrows, or other parts of the body. The hair loss is sudden and may extend from a few days to several weeks.

Alopecia can affect fingernails too. Some of the symptoms of Alopecia are:

• Many people experience a burning and stinging sensation on the affected areas before hair loss.
• Significant hair loss within a short period and on one side of the scalp.
• Chunks of hair fall out and accumulate on the pillow and shower.
• Formation of white spots and lines on the nails. Nails also lose their shine and become brittle.
• White hair appears on the affected areas.
• Occurrence of cadaver hair where hair break before reaching the skin’s surface.
• Formation of exclamation mark hairs (hairs that are narrow at the bottom) at the base of the scalp.

The good news is that hair regrows after a while as the hair follicles are not completely destroyed. Once the inflammation subsides, the hair starts regrowing and covering the bald patches.

You can witness full hair regrowth even if you have more than 50% hair loss. About 30% of people with Alopecia report that they experience an extensive cycle of hair fall and hair regrowth.

More than half of people with Alopecia recover within a year. Only 10% of individuals experience chronic Alopecia and Alopecia totalis or Alopecia universalis.

Hair Loss Prevention

Some types of genetic hair loss, such as male-pattern baldness, are irreversible but considering the following tips can lead to hair restoration and protection.

• Avoid pulling your hair when wet. Use a detangler or a wide-toothed comb to brush your hair. Limit your use of hair styling tools and hot oil treatments. Keep your hair loose and avoid using too many rubber bands or pulling your hair tight to prevent traction alopecia.
• Ask your doctor about the medication and treatments you are taking and see if they are causing hair loss.
• Wear a cap when going out and protect your hair from direct sunlight.
• Ask your doctor to give you a cool cap during chemotherapy sessions to prevent rapid hair loss.

Hair Loss Treatment

Exosome Therapy

Exosomes are extracellular vesicles that play a crucial role in cell communication, carrying proteins, lipids, and RNA between cells. In hair restoration, exosomes derived from mesenchymal stem cells have shown promise due to their regenerative, anti-inflammatory, and angiogenic properties. When applied to the scalp, these exosomes may stimulate hair follicle growth, activate hair follicle stem cells, and promote angiogenesis, potentially leading to increased hair density and coverage. ​

Platelet-Rich Plasma (PRP) Therapy

PRP therapy involves drawing a small amount of the patient’s blood, processing it to concentrate the platelets, and then injecting this platelet-rich plasma into the scalp. Platelets contain growth factors that can stimulate hair follicle activity and promote new hair growth. Studies have indicated that PRP injections can be effective in treating androgenetic alopecia, commonly known as pattern baldness, by preventing hair loss and encouraging regrowth. ​

Comparing Exosome Therapy and PRP

While both therapies aim to rejuvenate hair follicles and stimulate growth, they differ in their mechanisms and sources. PRP utilizes the patient’s own blood components, making it a personalized treatment. Exosome therapy, on the other hand, employs extracellular vesicles derived from stem cells, which may offer a more concentrated array of regenerative signals. However, it’s important to note that while PRP has been studied more extensively, exosome therapy is still under investigation, and more clinical data is needed to establish its efficacy and safety fully.

References:

1. https://www.niams.nih.gov/health-topics/alopecia-areata
2. https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
3. https://www.naaf.org/alopecia-areata
4. https://www.medicalnewstoday.com/articles/70956#Causes
5. https://www.healthline.com/health/alopecia-areata#diagnosis
6. https://pubmed.ncbi.nlm.nih.gov/39447204/