Most often, it starts with a sudden hair loss with the “cookie cutter”, in various places of the scalp. The hair follicle goes to rest without knowing why. Result: the hair is no longer nourished and ends up falling. This skin disease is thought to be of autoimmune origin (the immune system attacks the cells of the body). It mainly affects adolescents and young adults under 25, both men and women. There is undoubtedly a triggering factor: physical stress (illness, operation, pregnancy…) or psychological, in the days or weeks before, but this is not always the case. A family history is a contributing factor.
How to treat this hair loss?
The doctor usually prescribes corticosteroid creams, which calm the inflammation and play an immunosuppressive role. For more severe attacks and with a tendency to spread, corticosteroids are prescribed systemically (tablets).
At the same time, a treatment is associated to activate hair regrowth. These are “local irritant” products (minoxidil or Rubefiant® Gel from Ducray), which are applied to plaques either away from the corticosteroid intake, or immediately afterwards. During this period, the dermatologist follows the development of the plaques by taking pictures with a ruler to measure them, during regular appointments.
If the disease no longer progresses, it is necessary to wait for the regrowth. In the most serious cases, hospital treatment in a dermatology department may be necessary. General immunosuppressive treatment is then started.
How does alopecia areata evolve?
For a third of people, alopecia areata resolves spontaneously, that is, the hair grows back as before. For a second third, the plates stabilize. For others, there is an aggravation, which is manifested by an extension of the affected areas on the scalp.
More rarely, the other body hairs (beard, pubis, eyelashes and eyebrows included) can fall out, either just in patches or completely. In 10% of cases, the nails are affected in varying proportions: from small dots (like a thimble) to a real fall. It is then a more or less visible destruction of the nail. There may be recurrences, several times several years apart.
When does hair grow back?
Ideally, not for three months. Regrowth is slow! It usually takes between six and twelve months, which is often difficult for a woman. Hence the importance of dialogue and moral support on the part of the doctor.
And what to do in the meantime? As the problem is in the hair follicle, there is no risk to healthy hair. We can therefore continue to do the same treatments as before (coloring, styling products, etc.) on the areas that are not affected. Continuing to take care of yourself and your hairstyle is even recommended to play down the situation.
What are the current treatment options?
Different lasers (308 nm Excimer and fractionated CO2) have been tested in the context of alopecia areata, with rather convincing results. The same goes for local micropuncture therapy, rollerblading (toothed wheel that facilitates the penetration of active ingredients) or with mesotherapy (subcutaneous injection of vitamins). But these recent studies focus on small numbers and have not yet been validated on a large scale. For now, these techniques can therefore only be considered in severely affected patients and warned of the possible failure of these new treatments. Also on condition that you have the means, because they are expensive (between 150 and 300 € per session) and not reimbursed. •
Solutions when hair does not grow back
- Hair powders (Hair 30, Franck Provost) based on keratin fibers of different colors can advantageously camouflage plaques. They are eliminated with shampoo.
- A hair prosthesis (wig) may be prescribed by the doctor (management possible).
- Aesthetic and medical dermopigmentation consists of injecting pigments, point by point, into the middle dermis and under local anesthesia, on areas without hair. The goal ? Create the illusion of hair density and hide the plaques. It is preferably carried out in a doctor’s office by an experienced practitioner.
- The Dermofusion method aims to implant the patient’s hair on a very thin membrane attached to the scalp and changed every month. This added hair is undetectable. (Elite Hair International).
- Hair transplants can be a suitable solution for severe alopecia areata. It is a medical intervention under local anesthesia which requires taking good quality grafts.
Thanks to Dr Nina Roos, dermatologist