Alopecia Areata: Questions & Answers

Learn About Alopecia Areata Before Finding Your Solution

Understand why this hair loss disease affects hair follicles and how to cope with its unpredictable hair loss symptoms.

Q. What is alopecia?

A. Alopecia is simply the correct medical term for any type of hair loss.

Q. What is alopecia areata?

A. Alopecia areata is the most common form of an autoimmune skin disease resulting in patches of hair loss on the head or scalp. Alopecia areata usually starts with a small patch of hair loss and continues with one or more small, round patches of hair loss around the head in no predictable pattern and for no other known reason or disease.

Q. Is alopecia areata a rare disease?

A. According to current statistics on the disease, alopecia areata affects approximately 2 percent of the overall population, including more than 5 million people in the United States.

Q. How do you "get" alopecia areata?

A. Alopecia areata is classified as an autoimmune disease. A healthy human immune system contains an effective set of weapons against viruses, bacteria and parasites that can attack your body. But when a person's immune system mistakenly attacks the body itself, it is called autoimmunity and results in a disease such as alopecia areata, depending on which cells in the body are being attacked.

Q. What causes the hair loss?

A. With alopecia areata, the immune system is mistakenly attacking hair follicles and telling them to stop growing.

Q. Is alopecia areata a hair disease or a skin disease?

A. Alopecia areata is considered a skin disease because it occurs on the skin of the hair, or scalp, and is usually diagnosed by a dermatologist. Experts agree that usually bald patches are not affected by rashes, hives or itching, although exposed scalp areas do require extra care and protection from the sun.

Q. Can someone "catch" alopecia areata?

A. No. The disease is not caused by a virus or bacteria, and it cannot be spread between people.

Q. Why does the hair loss occur in random patches?

A. The telltale symptom of alopecia areata is the random patches of hair loss. The immune system is mistakenly telling only random hair follicles in random sections of the scalp to stop growing. Unaffected hair follicles will continue to grow normally as if nothing had happened.

Q. Is the hair loss condition caused by alopecia areata permanent?

A. There is no rhyme or reason to this type of autoimmunity that researchers have been able to discover so far, aside from a slight genetic component. The condition can reverse itself as unexpectedly as it started, and hair follicles will grow again as if nothing had ever happened. Sometimes the disease can progress and include more bald patches, or sometimes-new patches of hair loss may form while others grow in.

Q. What are some solutions to the patchy hair loss?

A. There is no way to halt the disease progression in any way or to treat the bald patches. Many doctors prescribe different treatments and medications based on an individual situation, and while some may work, others may not. Doctors agree that many times stress is a precipitating factor in the onset of the hair loss, so stress-reduction techniques are usually indicated, as well.

There are many studies being done on treatment solutions, but currently, non-surgical hair replacement and hair extensions are the best ways to cover the patches in order to improve the appearance of hair and feel better about your situation. Enlist the help of a qualified, experienced non-surgical hair replacement specialist to help determine the appropriate solutions to individual hair loss patches. Visit the National Alopecia Areata Foundation (www.naaf.org) for referrals to physicians experienced in treating alopecia areata, to find out about current research and treatments and to join support and advocacy groups.

Medications Can Prevent or Stop Hair Loss

But it is important to do your homework before trying any hair loss medication!



Hair loss medications can work. After approximately 15 years of widespread use for each, Propecia (finasteride) and Rogaine (minoxidil) have proven to be somewhat effective at halting and sometimes reversing hair loss. Medications are not for everyone, but for the hundreds of thousands of users of both medications, hair loss was defied -- it was not a fate that had to be accepted.

Propecia in particular, taken orally, is effective for 86 percent of users. About half actually regrow some lost hair, while for the other half the loss is simply stopped from advancing. Rogaine, which is applied topically to the scalp, is effective for only about 50 percent of those who use it. Both medications are more effective when used by individuals under age 40. The earlier in their hair loss experience that either medication is used, the more effective the results.

As with almost all forms of medication, finasteride and minoxidil come with side effects. Some are minor (skin irritation and itchiness, occasional growth of hair in unwanted places), others more significant (male fetuses can suffer significant adverse damage if the mother is exposed to Propecia). The individual user and family members present in the household need to be informed when choosing to use hair loss medications such as Propecia.

With both medications, hair loss resumes with discontinued use. The positive effects of Rogaine, hair counts and thickness, diminish after about five years of use.

And a note to women: Propecia is prescribed to men only, owing to the potential for birth defects (it also does not work in postmenopausal women), but Rogaine can be more effective for you than for men. Rogaine is now available over the counter -- no prescription required.

All of which shows it is essential to do your homework before trying hair loss medications.

Are Alternative Hair Loss Treatments for You?

There is no good reason not to consider alternative hair loss therapies or homeopathic treatments.



You might be the kind of person who looks for natural alternatives to pharmaceutical products. Perhaps you are skeptical about medicines that could cause more harm than good. So it may make sense for you to consider alternative hair loss treatments in your approach to preventing and treating hair loss.

Indeed, homeopathic medicines have been used for more than 200 years in Western culture to address health problems. Traditional approaches to medicine and health in Chinese, Indian and many other cultures go back even further. And a large number of them directly address the loss of hair.

In modern approaches to hair loss treatment and prevention, herbal and natural remedies (think saw palmetto and antioxidants) have some clinical research that backs the claims of their proponents. In an exciting development, stem cell therapy is being researched and may one day provide a very effective approach to hair loss prevention. Each offers alternative therapies to the three hair loss treatments that are currently approved by the U.S. Food and Drug Administration: Propecia (finasteride), Rogaine (minoxidil) and laser hair therapy.

There is no reason not to consider alternative hair loss therapies or homeopathic treatments. Our bodies and our hair are able to respond to different stimuli, different interventions and different preventive measures. We see this in weight loss, addiction treatment, mental health challenges and general health. But what works for one may not work for the other -- and vice versa.

Of course, the informed consumer knows that alternative therapies can also have a downside, so better to be educated on how things work and how to find qualified practitioners who can safely and effectively deliver treatments. This section offers several articles to help you find the alternative therapies that may halt or reverse hair loss.

Hair Extensions for Fashion and as a Hair Loss Treatment

Hair extensions are about reducing the stigma of missing hair.



Hair loss happens in many ways. Typically associated with male or female pattern baldness (a general thinning of hair in both sexes that is also known as androgenetic alopecia or androgenic alopecia), hair loss can happen in irregular patterns as well. Alopecia areata, characterized by hair loss patches, is one such condition. Other patchy hair loss conditions result from medications, including chemotherapy, and scalp trauma.

There is no fully effective treatment for hair loss patches, although some success may come through topical corticosteroids, steroid injections and ultraviolet light therapy. About 20 percent of those who suffer from alopecia areata have family members with the same condition.

An increasingly popular hair loss solution is the use of hair extensions. Because these use noninvasive methods, many women and men who use hair extensions feel more comfortable with this approach. ("Extension" is sometimes an inaccurate term, since they can be used with shorter hairstyles as well, simply to fill in the bald spot.) Salon specialists have become adept at this form of hair replacement, which attaches to existing hair, not to the scalp. Newer technologies also provide options for their application -- a "cool" approach allows use by trauma and chemotherapy patients, while a time-proven "hot" method offers a broader range of styling options.

Which is exactly the point. Hair extensions are about reducing the stigma of missing hair. But they also allow the individual to explore new fashions, styles that can make for a whole new you. In this instance a hair loss patch can in fact open up an opportunity.

If you think hair extensions are for you, read on. A good hair extension applied by a savvy, professional stylist works best when the client knows how to skillfully address a hair loss patch.

Scalp Massage: Rubbed Right

Learn the Benefits of Scalp Massage to Treat Hair Loss

Many hair loss patients have had success using this practice, although evidence is anecdotal. But a daily scalp massage feels great and is all-natural.

While much of the evidence involving hair loss, hair regrowth and effects from scalp massage is anecdotal, one study published in the Archives of Dermatology ("Randomized Trial of Aromatherapy: Successful Treatment for Alopecia Areata") in November 1998 found that 44 percent of alopecia areata patients who performed a two-minute daily scalp massage with a mixture of essential oils of thyme, rosemary, lavender and cedar wood, in a base of jojoba and grape seed oils, noticed thicker hair and new hair growth, including one man who completely regrew hair from an almost completely bald scalp.

Most hairstylists, hair replacement specialists and hair loss sufferers alike agree that scalp massage, done gently, is part of an overall care plan depending on the actual diagnosis of your hair loss condition. "We've used a vibrating scalp massage brush, and you can actually see the blood rush to the scalp, to stimulate blood flow to the follicles," says Diahna Husbands, hair replacement specialist and owner of Diahna Lynn Hair Studios in the Washington, D.C., metropolitan area.

Is scalp massage and aromatherapy the right hair loss treatment for me?

• I want to try nonsurgical, nonpharmaceutical, natural remedies.
• I believe in the benefits of massage and aromatherapy.
• I believe in a whole-body approach to my health.
• I am familiar with essential oils.
• I rely on alternative therapies for my health issues.
• I can commit to a daily regimen for several months.

How do scalp massage and aromatherapy work against hair loss?

Scalp massaging with or without the use of natural botanicals is a practice that has been used throughout history by many ancient and modern cultures. In fact, the Indian head massage comes from India, where it is carried out regularly on all family members to keep scalp and hair in good condition, relieve tension and promote health. As Husbands said, the most obvious benefit of scalp massaging is the instantaneous increase in blood flow and circulation in the region, which nourishes hair follicles. Stress and tension, which can restrict blood flow to the follicles, and sebum plugs and excess dead skin, which can block hairs from exiting the follicles, can all be improved by massaging the scalp on a daily basis. Melanie Vonzabuesnig, a certified aromatherapist specializing in formulas for scalp and hair conditions and the author of Hair Loss in Women ... Getting to the Root of the Problem, reports that the benefits of scalp massage are greatly increased by adding essential oils to the regimen because of their ease of absorption; antibacterial, antifungal, anti-inflammatory properties; and well-known energizing, invigorating effects on both the skin and the underlying cellular regeneration process. Some say essential oils can actually penetrate the cuticle and renew hair from within.

Many hairstylists also have been adding scalp massage to their shampoo regimens for clients, whether or not they are experiencing hair loss. In fact, as New York City hairstylist Xac Cruz explains, "Adding massage techniques to a shampoo session or, as I like to call it, a 'Hair Bath' is not only an amazing, relaxing and unexpected treat, but also it improves blood circulation, which delivers nutrients to the hair and scalp. I use acupressure points, called tsubo in Japan." Tsubo points are weak spots along an energy path and typically occur near joints, in the depressed junctures where muscles meet. Two points are easily found at the natural hollow between the ear and the middle line of the neck at the base of the skull. You can apply gentle pressure to tsubo points and in just a few seconds help relieve tension and open up pathways. Edmondo Blando, owner of Salon Vanity in Philadelphia, has taken it a step further and created soothing rinsing techniques, such as his "hair waterfall," and he incorporates his all-time favorite Moroccanoil into his clients' scalp massage treatments.

What can I expect from scalp massage and aromatherapy?

You can order scalp massage oils, even the one from the study above, from essential oil companies and massage them in for use overnight, or you can slip in some shiatsu and other scalp massage techniques while you shampoo in the shower. A smart way to get great technique tips is from a certified massage therapist (if you know one), or watch and learn from one, such as the one featured on this great free Videojug video (www.videojug.com/film/how-to-do-an-indian-head-massage), which uses a nationally certified massage therapist to demonstrate the steps in an Indian head massage. This way you can adopt the techniques that feel best to you. And remember -- be gentle -- because the last thing you want to do is create stress on weak hair by rubbing too harshly and pulling hairs out.

• Once hair is wet or oiled, use your fingertips to perform circles at either side of the base of the neck. This is a good place to hold gentle pressure at the base of the hairline/skull for a few seconds.
• Fan fingers upward and stroke up into the hair roots. At neckline glide hand up into the hairline. Repeat glide. (If shampooing, however, stylists agree that you should keep the shampoo at the scalp only; do not pile hair up on top of the head or rub throughout hair shaft, because this only distresses the hair cuticle, dries it out and roughs it up.)
• Bring hands to the side of your hairline in a fan with fingers pointing up. With heel of hands in contact with the scalp use a circular-fingertip motion to massage around hairline. Repeat this motion toward the crown, massaging shampoo/oil gently all around other areas of the scalp.
• You can also rub vigorously back and forth, using small motions all over for a more intense feeling, if you like it. Keep fingertips in contact with the scalp at all times to minimize roughing of the hair.
• Slowly reduce rubbing to stroking fingers through the hair and move to the top of the forehead and use the fingertip circles again to move down the hairline, ending with gentle circles at the temples.
• End the massage by stroking fingers downward over scalp, slower and slower. If shampooing, rinse using a "water-fall" motion.

If you have shampooed, apply conditioner to the ends first, then the midshaft. Use a sweeping motion to distribute conditioner throughout hair, but not so much the scalp, where conditioner does nothing, advises Nicholas Penna, owner of Salon Capri, who has been styling hair in the Boston area for over 40 years.

Complications of scalp massage

Do not use any botanicals that you know you are allergic to and always perform an overnight patch test behind your hair to be sure -- you don't want to exacerbate your condition with any type of allergic reaction. If you are working with a practitioner be sure to tell the individual about any allergies or sensitivities and disclose your full hair loss diagnosis.

The bottom line on scalp massage and aromatherapy as a hair loss treatment

This type of treatment works best for those who have the time and patience to follow the practitioner's plan exactly and to take a whole-body approach to their hair loss.

Also, results may or may not be noticeable in six to eight months, depending on your hair loss diagnosis, so keep doing it as long as it feels good.

Hair Regrowth Therapy for Women

Hair Regrowth Therapy Can Reverse Women's Hair Loss

Cultural standards of beauty being what they are, hair loss in women is particularly difficult. But there are several ways in which women can stop losing hair and sometimes gain some back.

It is a sobering fact that approximately 40 percent of women experience some type of hair loss in their lifetimes. Some of it is just a phase and reversible -- for example, after giving birth, after surgery, during chemotherapy treatments or when physically shocked by undernourishment, as happens with severe anorexia or crash dieting. But women's equivalent to male pattern baldness -- technically known as androgenic (or androgenetic) alopecia -- can be just as irreversible as with men. Some hair loss that is reversible in most women ends up as a permanent loss in others.

There are, however, answers in certain therapies that can slow, stop and sometimes reverse hair loss. The educated woman has many tools at her disposal; the key point is to use the right methods and to use them as soon as possible. One promising method is hair regrowth therapy.

Hair regrowth therapy: Topical treatments can stop female hair loss

While largely marketed as a way for men to reduce hair loss, Rogaine (generic name minoxidil) for women is in fact found to be effective. A 2 percent solution is recommended for women, but physicians are able to prescribe a 5 percent solution to them even though product indicators state it is for men (testing on women is limited because of the risks in testing anything on premenopausal women, and the 5 percent Rogaine solution is often too harsh for sensitive skin). Nineteen percent of women using the 2 percent solution experience a moderate regrowth of hair, while 40 percent of women exhibit minimal regrowth.

Systemic (internal, taken orally) solutions such as finasteride (Propecia) are resolutely not recommended, despite a high rate of success in men. This is due to the fact that the product can cause serious birth defects when ingested by women who are pregnant (merely touching a broken tablet can have the same effect). Also, tests on postmenopausal women found that it was largely ineffective anyway.

Hair regrowth therapy: Laser hair therapy can stimulate female hair follicle vitality

In almost every midsize to major city in the United States (and much of the developed world as well), there exists at least one hair regrowth facility that employs laser hair therapy as a core treatment method. Laser hair therapy uses photobiostimulation, which increases blood flow to the scalp, bringing nutrients that improve the overall health of the hair follicle. With this, existing hair is less likely to decline. In some cases, existing follicles that were in dormancy are brought back to normal growth.

One such hair regrowth facility that employs laser stimulation is Transitions of Indiana, an Indianapolis-based center where the majority of clients are women. "Most are between the ages of 40 and 70 years old," explains Melissa Green, a hair loss consultant who works daily in laser therapy. "Most women and men suffer from androgenetic alopecia. We do treat men and women with different types of alopecia such as alopecia areata [baldness in patches]. Laser hair therapy is also a very effective and safe treatment protocol for individuals who have been through chemotherapy or radiation."

How well does it work? "The expectations of the clients are to slow down the rate of their hair loss and to partially restore their hair," says Green. "Typically, laser hair therapy is most effective when done in a series of treatments. For that alone, we don't recommend a client to just have a couple of treatments, because it would not produce any results." Costs for their program are in the ballpark of $2,000; however, costs vary by market and according to ancillary services, such as scalp massages and cleansing, which can double and triple what customers pay.

Hair regrowth therapy: Combination hair loss prevention therapies for women are effective

Another clinic, Hans Wiemann Hair Replacement, located near St. Louis, Missouri, offers a program that includes twice-a-week appointments of 20 minutes each, plus a once-every-two-weeks scalp cleansing and therapeutic massage. Both the Missouri and Indiana facilities apply or sell shampoos and scalp treatments containing nutrients and vitamins that promote circulation of blood to the scalp and hair follicles. "We offer a full range of scalp treatments to act in the global wellness approach to the overall health of the internal hair follicle," says Green.

Green says their program will yield results in 60 to 90 days but greater results can be achieved after that. "The longer a person does laser, the more stimulation is occurring and the higher the success rate." She says the overall success rate is 85 percent but that "laser isn't designed to regrow hair if the follicle is no longer producing hair. If that were the case, there would never be a need for other modalities such as hair transplantation or non-surgical grafting."

Early-Stage Laser Hair Therapy Can Be Effective

For thinning hair, laser hair therapy could be the perfect hair loss treatment.



Laser hair therapy works -- specialists who administer it explain that it can improve hair count by 10 percent. While often confused with the removal of unwanted hair, hair loss laser therapy has found its adherents for several reasons. One is that it does not require taking hair loss medications, such as Rogaine or Propecia (however, some patients claim a synergistic effect from combining either with hair loss laser therapy). For people who are showing signs of becoming bald but are not ready to consider a hair replacement system, laser hair therapy is an option worth exploring.

How does laser hair therapy work? Hair loss laser therapists explain that it widens faltering hair follicles, stimulating them to repair and regain the ability to grow hair shafts that may have been getting smaller in the hair loss process. The person who seeks hair loss laser treatments while still in the early phases of thinning hair will experience the best results. The significantly bald person will not be able to stimulate growth in hair follicles that are largely defunct.

Notably, the FDA has cleared therapeutic baldness laser therapy for being safe. The agency does not vouch for effectiveness.

You can administer laser therapy yourself or have it professionally done. The methods involve different levels of diode exposure, with varying levels of results as well. In a laser hair therapy studio, a trained professional will guide and monitor the treatment, which typically involves three appointments per week. The at-home approach involves the use of hand-held laser combs and laser brushes and takes just as much time. Treatment at regular intervals is considered essential to success in stimulating hair growth.

Whether you try it at home, go to a salon or consider alternative hair loss remedies, you need to study your options.