What is alopecia?
Alopecia is a broad term that refers to any form of hair loss, said Dr. Angela Lamb, a board-certified dermatologist at Mount Sinai in New York City. It can have many causes. Some people — especially men — lose scalp hair with age because of changes in hormones known as androgens, she said, and that is considered a form of alopecia. A type of hair loss common in the Black community is traction alopecia, which occurs when hair has been pulled tight for too long.
Other people lose hair because their immune system starts attacking their hair follicles in what is known as autoimmune alopecia. Autoimmune forms of alopecia can be caused by discoid lupus erythematosus, which can lead to sores and scarring on the face and scalp. Central centrifugal cicatricial alopecia is another immune-related condition that causes scalp scarring and permanent hair loss. CCCA almost exclusively arises among Black women between ages 30 and 55, and research suggests it may afflict as many as 15 per cent of such women.
Another common form of autoimmune alopecia is alopecia areata. When people talk about alopecia, they are often referring to this type, which affects 1 in every 500 to 1,000 people in the United States. It's unclear what kind of alopecia Pinkett Smith has, but her appearance suggests it is alopecia areata, said Dr. George Cotsarelis, a dermatologist at the Perelman School of Medicine at the University of Pennsylvania.
When, why and how does alopecia areata occur?
Alopecia areata can arise in childhood, adolescence or adulthood, Lamb said. People who have the condition tend to lose hair in clumps, she said, causing round bald spots. (The word "areata" refers to the patchy nature of the hair loss; when a person loses all their scalp hair, it's called alopecia totalis, and when they lose all their body hair, it is referred to as alopecia universalis.) Some people with alopecia areata lose patches of hair only on their scalp, while others lose it elsewhere on their body as well, she said.
More than half of the time, hair that has fallen out grows back within a year, Cotsarelis said. But often, months or years later, people develop other bald patches, too.
It's unclear what causes alopecia areata, but Lamb noted that it can have a genetic component. If a parent has alopecia areata, for instance, their child has a 1 per cent to 10 per cent chance of developing it, too, she said. Alopecia areata can also be triggered by stressful events and by nutritional deficiencies, such as iron deficiency, Cotsarelis said.
Doctors diagnose alopecia areata by taking a biopsy of the scalp and then sending it to pathologists who study the skin cells under a microscope to determine what may be causing the hair loss.
People with alopecia areata are more likely than those who don't have the condition to develop related conditions, too, such as thyroid disease, diabetes, allergies and asthma, Cotsarelis said.
How is alopecia areata treated?
A handful of drugs can manage alopecia areata, but some treatments aren't effective for some people, Lamb said, so patients may need to try multiple approaches before settling on something that works.
The good news is that with alopecia areata, "your hair always has the ability to regrow if you get rid of the inflammation," Cotsarelis said.
One common treatment is the injection of anti-inflammatory drugs such as steroids directly into the affected parts of the scalp to stop the body from attacking the hair follicles, Lamb said. These injections may be given monthly and can cause side effects such as skin discolouration or small dimples. Some people also use topical corticosteroid treatments, such as betamethasone valerate.
Another medication that doctors have recently started using is a monoclonal antibody called dupilumab, a drug that has long been used to treat asthma and eczema, Lamb said. Dupilumab can be injected into the thigh or arm once every two weeks and rarely causes serious side effects, she said.
Some doctors have started treating the condition with oral medications such as tofacitinib and baricitinib, which are approved by the Food and Drug Administration to treat rheumatoid arthritis but have also been shown to help with hair loss, Cotsarelis said. But these oral drugs can have serious side effects, he noted, increasing the risk for blood clots and lymphoma, and more research is needed on their long-term effects.
Sometimes, alopecia areata resolves on its own, but generally, there is no cure, Lamb said. In part because of that, the diagnosis of alopecia can be distressing, she said — but with the right treatments, many people do see improvement. Often, "we can get you to a place where you don't even notice the condition anymore," she said.
This article originally appeared in The New York Times.
Written by: Melinda Wenner Moyer
Photographs by: Hunter Abrams
© 2022 THE NEW YORK TIMES
