There are numerous autoimmune conditions, and most of them may cause hair loss. Systemic autoimmune diseases like Graves disease and discoid lupus erythematosus cause hair loss. However, there are also specific autoimmune conditions with hair loss as the primary presenting symptom, like Alopecia areata.
In systemic autoimmune conditions like lupus, people generally experience hair thinning, though complete baldness is rare. However, more specific conditions like alopecia areata are characterized by progressive hair loss. Studies suggest that the
lifetime risk of alopecia areata is about 2% and that about one in a thousand is living with the condition.
As the name suggests, autoimmune conditions occur when the immune system wrongly starts attacking hair follicles – especially true for alopecia areata. However, in other autoimmune diseases, hair loss may also occur due to systemic inflammation and nutritional deficiencies.
Although genetics is a known risk factor for autoimmune hair loss, there are other factors, like environmental factors. Further, people
who are living with psoriasis, thyroid disease, vitiligo, and various allergies are more likely to experience alopecia areata.
When it comes to presentation, it is quite varied. It may be:
- Patchy hair loss: The most common type of hair loss occurs in small patches, often the size of a coin.
- Alopecia totalis: A less common type, causing loss of all hair on the scalp.
- Alopecia Universalis: A rare type, when there is complete hair loss, not only on the scalp but also on the rest of the body, including eyebrows.
Fortunately, about
50% of those experiencing autoimmune hair loss will not have severe hair loss, and they are also quite likely to recover within a year. Such patients respond well to most commonly used treatment methods like topical minoxidil and do not essentially require corticosteroids or other immune modulators.
However, managing autoimmune hair loss in the rest of the patients is quite challenging. Different treatment approaches may be required depending on hair loss severity and how well the person responds to a specific treatment.
Here are
some treatment options:- Application of topical corticosteroids on bald spots.
- Application of topical minoxidil to promote hair regrowth. It may be used after stopping corticosteroids.
- Those who do not respond to topical corticosteroid application may benefit from local injection of corticosteroids. Generally, corticosteroids are injected into the spots of hair loss for three months, with intervals of 4-6 weeks.
- Some patients may benefit from topical anthralin.
However, extensive hair loss may require systemic therapy, including oral corticosteroids. Many may benefit from a new class of JAK inhibitors called Ritlecitinib or Barcitinib. These drugs may increase hair growth by more than 50%.
