What is Alopecia?
Alopecia is an incurable autoimmune disease that causes sudden and unpredictable hair loss on the scalp, face, and sometimes on other areas of the body. Commonly, those with alopecia experience hair loss in patches, while in more extreme cases, alopecia can result in complete hair loss on the scalp or even throughout the entire body.
Although alopecia is commonly mistaken as a hair-only condition, it's much deeper than hair alone. Affecting nearly 6.8 million people in the US and approximately 147 million worldwide5, alopecia is a disease that does not discriminate against age, gender, or ethnicity, and presents itself as an array of physical health challenges which are often accompanied by emotional impacts.
Causes
Many contributing factors lead to developing alopecia areata. A very complicated and startling condition, alopecia is an autoimmune disease that attacks the normal cells in your body and mistakes them for foreign objects by attacking them. The autoimmune system doesn't recognize the cells and in turn, destroys healthy hair follicles, causing various degrees of hair loss4.
Scientists have continued research to try to understand what causes the immune system to attack the cells to identify the "triggers", and haven't determined a specific cause. Researchers aren't sure if the cause stems from inside of the body (from a virus, bacteria, etc.), from external factors, or a combination of factors4.
Types
Alopecia has been found in many forms, identified as a specific variation of the disease. Overall, each type of alopecia recognizes healthy hair follicles as a threat and attacks them, causing them to get significantly smaller and dramatically slow down the production of new cells. As the rate of cell growth decreases, it's harder for the body to maintain hair growth which leads to little, moderate, or complete hair loss4.
Depending on the type and severity of alopecia you may be experiencing, hair loss may appear in different areas of the body and regrowth can be unpredictable and cyclical, meaning that it can be recurrent for months or years4. Each type of alopecia is defined by the behavior and nature of hair loss as it appears in different areas of the body. Because the characteristics and personalities between types vary, they may have slightly different methods for prognosis and treatment.
The three well-known types of alopecia are:
- Alopecia areata — Known as the most common form of alopecia, this type appears as one or more coin-sized hairless patches on the scalp or other areas of the body
- Alopecia totalis — Totalis, meaning "the sum total or the whole amount" results in complete loss of the hair on the scalp
- Alopecia universalis — This type refers to overall (universal) and complete loss of hair on the scalp, face, and body
Learn more about the different types of alopecia areata
Symptoms
Although alopecia is different for everyone and symptoms may vary, the primary symptom of the disease is hair loss. Hair typically falls out in small, round or oval patches on the scalp or beard, and may also affect other areas of the face including eyebrows, eyelashes, or other parts of the body.
Many have reported that they noticed their first signs of hair loss or unusually larger clumps of hair while taking a shower or on their pillow. It’s important to note that other conditions can cause your hair to fall out in a similar pattern – hair loss is not the only factor in diagnosing alopecia, so it’s important to schedule an appointment with a doctor to identify and confirm your symptoms2.
Additional symptoms of alopecia also include:
- Simultaneous hair loss and regrowth in different areas of the body
- Significant hair loss in a very short period
- Hair loss that’s mostly on one side of the scalp, instead of both sides
- “Exclamation point” hairs that are narrow at the base/next to the scalp
- “Stippling” or “Pitting” (rows of tiny dents) on the fingernails
In rare and extreme cases, symptoms are more severe and result in total hair loss in certain areas or complete hair loss across the entire body. These cases are identified by specific types of alopecia, such as alopecia totalis, which is the loss of all hair on the scalp, and alopecia universalis, which is the loss of all hair on the entire body.
Because of the sudden and unpredictable nature of alopecia, there isn’t a proven way to predict or expect the pattern of hair loss, the severity of loss, how long it will last, or regrowth that you will experience along your journey.
If you identify with any or all of these symptoms, it’s important to schedule an appointment with a doctor to determine a formal diagnosis and receive medical advice for treatment options and next steps.
Is Alopecia Genetic?
Alopecia areata is a polygenic disease, a genetic disease that is caused by the combined action of more than one gene6. This means that it requires the contribution of many genes to be inherited from both parents to cause alopecia, as well as contributions from the environment. However, according to the National Alopecia Areata Foundation (NAAF), “most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children5.”
Because alopecia is such a complex disease that is still being closely studied, scientists have yet to find an accurate calculation of the risk of passing alopecia along to children due many contributing factors and risks from several genes. Scientists believe that due to the various number of possible of genes that predispose certain people to alopecia, it’s highly unlikely that a child would inherit all genes needed to guarantee that they adopt the disease4.
NAAF research suggests that Even with the right (or wrong) combination of genes, developing alopecia areata is still not a certainty.
Alopecia in Kids and Teens
Alopecia may begin and be diagnosed at any age1, however, according to the American Academy of Dermatology, most people develop it by 30 years of age. For many, the disease begins during childhood or the teenage years3.
If you're a parent, family member, or guardian of a child suffering from alopecia looking to support them, explore our resources for kids and teens.
Learn more about alopecia in kids and teens.
Alopecia in Pets
Can pets have alopecia? Yep, they sure can.
It’s completely normal for your furry friend to shed its hair, even lots of it. However, if your cat or dog is shedding amounts of hair that lead to visible patches or bald spots, it may be time to visit a veterinarian and learn more about alopecia in pets.
Alopecia and Diet
Because alopecia is an autoimmune disease, those who have the condition may consider or be advised to adopt an anti-inflammatory diet. An anti-inflammatory diet aims to reduce the body’s autoimmune response and reduce the risk of hair loss episodes and progressive hair loss.
To abide by such a diet, it’s recommended to eat foods that are known to ease the inflammation process2. According to Jacquelyn Cafasso, health and pharmaceutical research analyst, “The foundational foods of this diet, also known as the autoimmune protocol, are fruits and vegetables like blueberries, nuts, seeds, broccoli, beets, and lean meats like wild-caught salmon.” It’s best to avoid foods with sugar, processed snacks, and alcohol, as they have been known to increase inflammation and irritation in the body, and in turn, opt for a more balanced diet; one with whole grains, fruits, vegetables, and lean meat2.
Connections To Gut Health
Researchers suggest that probiotics may assist in the mitigation and treatment of alopecia, a theory that has been explored in recent years. Scientists are acknowledging within the field of complementary health that auto-immune conditions stem from the gut7. It’s common for those suffering from alopecia to also experience forms of digestive conditions and may experience extreme or prolonged stress and anxiety which poses challenges for digestion, altering the bacteria in the gut (gut flora).
Stress is a major factor in negatively influencing digestion, as it’s known to reduce the flow of blood and nutrients through the digestive tract. When stress is severe, it can also lower the levels of ‘friendly’ bacteria in the gut, which can lead to an overgrowth of pathogenic strains of bacteria that release a variety of toxins and inflammatory factors and damage the intestinal wall. When this happens, the body will experience what’s called a ‘leaky gut’, when the epithelial lining of the GI tract has become permeable or ‘leaky’. As the gut ‘leaks’, toxins and particles of partially digested food can slip into the bloodstream and cause many different health complications7.
A study by Optibac Probiotics suggests that “one of the biggest impacts of having a leaky gut is the burden this places on the immune system. Undigested food particles, that should not be present in the bloodstream, causing the immune system to mount an immune response against them7”. If this occurs frequently, the immune system becomes hypersensitive and turns on itself, and attacks its tissue, which directly impacts alopecia because it can lead to the elimination of hair follicles and hair loss.
Nutritional Therapist Kathy Wheddon also notes that by making efforts to support healthy digestion, those with alopecia may reduce the burden on the immune system and trigger autoimmune responses that lead to hair loss7. “I would usually recommend that clients of mine, with an auto-immune condition, remove the most common allergens from their diet, which includes all grains and all dairy products. Additionally, they should try to manage their stress levels wherever possible.
Treatment
Fortunately, there are many treatments available to treat the various forms of alopecia. To ensure that you are properly diagnosed, it’s important to schedule an appointment with a doctor to determine a treatment plan receive medical advice and next steps.
Learn more about alopecia treatments.