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==Overview==
==Overview==
Patients with alopecia are at increased risk of psychosocial complications such as anxiety and depression. In addition, these patients need to be evaluated for other medical conditions. Outcomes vary with the type of alopecia.
The severity and progression of [[alopecia]] are dependent on the cause. Patients with [[alopecia]] are at increased risk of psychosocial complications such as [[anxiety]] and [[depression]]. In addition, these patients need to be evaluated for other medical conditions. Outcomes vary with the type of a[[lopecia]].


=Alopecia natural history, complications and prognosis=
=Alopecia natural history, complications, and prognosis=


==Natural History==
===Natural History===
The term alopecia (/ˌæləˈpiːʃiə/) comes from alōpēx, meaning "fox" in Greek. This usage originated either from the fox shedding its coat twice a year, or because in ancient Greece foxes often lost hair because of mange.  
The progression of [[alopecia]] depends on the type of [[alopecia]] an individual has. In some cases, it is irreversible as in [[alopecia mucinosa]], [[alopecia neoplastica]], and long-standing cases of [[tinea capitis]]. In other cases, it is reversible such as in [[anagen effluvium]]. In males with [[androgenetic alopecia]], the hairline regression occurs mostly at the [[temporal]] areas bilaterally and [[vertex]] balding is also seen. In females with [[androgenetic alopecia]], the frontal hairline is largely unaffected while in other areas, there is hair thinning <ref name="pmid921894">{{cite journal| author=Ludwig E| title=Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. | journal=Br J Dermatol | year= 1977 | volume= 97 | issue= 3 | pages= 247-54 | pmid=921894 | doi=10.1111/j.1365-2133.1977.tb15179.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=921894  }} </ref> <ref name="pmid24039457">{{cite journal| author=Levy LL, Emer JJ| title=Female pattern alopecia: current perspectives. | journal=Int J Womens Health | year= 2013 | volume= 5 | issue=  | pages= 541-56 | pmid=24039457 | doi=10.2147/IJWH.S49337 | pmc=3769411 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24039457  }} </ref>. In [[telogen effluvium]], it could take as much as 6 months for hair  to begin growing again, and it often takes more time for the hair growth to be perceptible to the patient.


==Complications==
===Complications===
=== Psychological Effects ===
* In general, people with [[alopecia]] are at a greater risk of developing socio-psychological problems such as [[anxiety]] and depression as a result of hair loss.
The psychological effects for individuals experiencing hair loss vary widely. Some people adapt to the change comfortably, while others have severe problems relating to anxiety, depression, social phobia, and in some cases, identity change.
* Other than progressive disease, complications of [[alopecia areata]] are inherent to the treatment of choice. However, a study revealed that [[alopecia areata]] may be associated with a greater risk of development of insulin resistance. <ref name="pmid31089876">{{cite journal| author=Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S| title=Patients with alopecia areata show signs of insulin resistance. | journal=Arch Dermatol Res | year= 2019 | volume= 311 | issue= 7 | pages= 529-533 | pmid=31089876 | doi=10.1007/s00403-019-01929-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31089876  }} </ref>
[[Image:StoryMusgrave.jpg|thumbnail|left|195px|Retired bald NASA astronaut Story Musgrave.]]
* [[Tinea capitis]] can lead to irreversible hair loss if untreated, ridicule, and psychosocial impairment in children.
Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. Body image does not return to the previous state after regrowth of hair for a majority of patients. In such cases, patients have difficulties expressing their feelings ([[alexithymia]]) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise.<ref>{{cite journal | author=Poot F | title=[Psychological consequences of chronic hair diseases]| journal=Rev Med Brux | volume=25 | issue=4 | pages=A286-8 | year=2004 | id=PMID 15516058}}</ref>
* If alopecia is secondary to another disease such as [[hypothyroidism]], [[syphilis]], [[Cushing syndrome]], [[malnutrition]] or [[systemic lupus erythematosus]], complications would be the same as the underlying disease.
Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.<ref>{{cite journal | author=Passchier J, Erdman J, Hammiche F, Erdman R | title=Androgenetic alopecia: stress of discovery. | journal=Psychol Rep | volume=98 | issue=1 | pages=226-228 | year=2006 |id=PMID 16673981}}</ref>


===Associated Medical Conditions===
===Prognosis===
Patients with alopecia need to be assessed for other autoimmune conditions such as thyroid conditions, vitiligo, etc. People with alopecia areata may at increased risk of developing insulin resistance. <ref name="pmid31089876">Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=31089876 Patients with alopecia areata show signs of insulin resistance.] ''Arch Dermatol Res'' 311 (7):529-533. [http://dx.doi.org/10.1007/s00403-019-01929-6 DOI:10.1007/s00403-019-01929-6] PMID: [https://pubmed.gov/31089876 31089876]</ref>
* In [[telogen effluvium]], recovery is usually good.
* [[Androgenetic alopecia]] is a progressive disease that tends to worsen with time. <ref name="pmid24566563">{{cite journal| author=Piraccini BM, Alessandrini A| title=Androgenetic alopecia. | journal=G Ital Dermatol Venereol | year= 2014 | volume= 149 | issue= 1 | pages= 15-24 | pmid=24566563 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24566563  }} </ref>
* In the majority of [[anagen effluvium]] cases, cessation of chemotherapy often leads to hair regrowth. However, it could take up as much as a few years to achieve a full recovery of hair. Less commonly, full recovery does not occur.
* [[In alopecia areata]], about 34–50% of patients will recover spontaneously in 1 year or less with majority of them having recurring episodes of alopecia. Progression [[alopecia totalis]] or [[alopecia universalis]] occurs in 14–25% of patients and of those patients, complete recovery is seen in less than 10% of cases. The degree of hair loss and age of the patient at initial diagnosis may play a role in the outcome of the disease, with onset in childhood being associated with a poorer prognosis compared to a later age. <ref name="pmid28300084">Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28300084 Alopecia areata.] ''Nat Rev Dis Primers'' 3 ():17011. [http://dx.doi.org/10.1038/nrdp.2017.11 DOI:10.1038/nrdp.2017.11] PMID: [https://pubmed.gov/28300084 28300084]</ref> Patients with a positive family history of alopecia areata, presence of accompanying autoimmune disease and personal history of atopic diseases may also indicate poorer outcomes. <ref name="pmid10727299">{{cite journal| author=Madani S, Shapiro J| title=Alopecia areata update. | journal=J Am Acad Dermatol | year= 2000 | volume= 42 | issue= 4 | pages= 549-66; quiz 567-70 | pmid=10727299 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10727299  }} </ref>
*The prognosis of [[tinea capitis]] is excellent when patients are treated early. However, if left without treatment, patients may develop an abscess known as a kerion. This could lead to permanent hair loss.


==Prognosis==
Research has shown that about 8.5% of patients with alopecia totalis and universalis achieved a total recovery. Many of the patients will obtain at least a transient recovery of partial or total hair regrowth. Response to treatment is often unpredictable, and healthcare providers should be aware of the prognosis and its effects to properly counsel patients. <ref name="pmid31593606">Burroway B, Griggs J, Tosti A (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=31593606 Alopecia totalis and universalis long-term outcomes: a review.] ''J Eur Acad Dermatol Venereol'' 34 (4):709-715. [http://dx.doi.org/10.1111/jdv.15994 DOI:10.1111/jdv.15994] PMID: [https://pubmed.gov/31593606 31593606]</ref>
Many companies have built a successful business selling products that reverse baldness, by allegedly regrowing hair, transplanting hair or selling hairpieces. There is very little evidence that any of those which claim hair regrowth actually work.
The Alopecia Areata Predictive Score is a trichoscopy-based assessment used to predict the treatment outcome in patients with patchy alopecia areata. <ref name="pmid31301100">Waśkiel-Burnat A, Rakowska A, Sikora M, Olszewska M, Rudnicka L (2020) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=31301100 Alopecia areata predictive score: A new trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata.] ''J Cosmet Dermatol'' 19 (3):746-751. [http://dx.doi.org/10.1111/jocd.13064 DOI:10.1111/jocd.13064] PMID: [https://pubmed.gov/31301100 31301100]</ref>
==References==
==References==
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Latest revision as of 16:46, 28 January 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD

Overview

The severity and progression of alopecia are dependent on the cause. Patients with alopecia are at increased risk of psychosocial complications such as anxiety and depression. In addition, these patients need to be evaluated for other medical conditions. Outcomes vary with the type of alopecia.

Alopecia natural history, complications, and prognosis

Natural History

The progression of alopecia depends on the type of alopecia an individual has. In some cases, it is irreversible as in alopecia mucinosa, alopecia neoplastica, and long-standing cases of tinea capitis. In other cases, it is reversible such as in anagen effluvium. In males with androgenetic alopecia, the hairline regression occurs mostly at the temporal areas bilaterally and vertex balding is also seen. In females with androgenetic alopecia, the frontal hairline is largely unaffected while in other areas, there is hair thinning [1] [2]. In telogen effluvium, it could take as much as 6 months for hair to begin growing again, and it often takes more time for the hair growth to be perceptible to the patient.

Complications

  • In general, people with alopecia are at a greater risk of developing socio-psychological problems such as anxiety and depression as a result of hair loss.
  • Other than progressive disease, complications of alopecia areata are inherent to the treatment of choice. However, a study revealed that alopecia areata may be associated with a greater risk of development of insulin resistance. [3]
  • Tinea capitis can lead to irreversible hair loss if untreated, ridicule, and psychosocial impairment in children.
  • If alopecia is secondary to another disease such as hypothyroidism, syphilis, Cushing syndrome, malnutrition or systemic lupus erythematosus, complications would be the same as the underlying disease.

Prognosis

  • In telogen effluvium, recovery is usually good.
  • Androgenetic alopecia is a progressive disease that tends to worsen with time. [4]
  • In the majority of anagen effluvium cases, cessation of chemotherapy often leads to hair regrowth. However, it could take up as much as a few years to achieve a full recovery of hair. Less commonly, full recovery does not occur.
  • In alopecia areata, about 34–50% of patients will recover spontaneously in 1 year or less with majority of them having recurring episodes of alopecia. Progression alopecia totalis or alopecia universalis occurs in 14–25% of patients and of those patients, complete recovery is seen in less than 10% of cases. The degree of hair loss and age of the patient at initial diagnosis may play a role in the outcome of the disease, with onset in childhood being associated with a poorer prognosis compared to a later age. [5] Patients with a positive family history of alopecia areata, presence of accompanying autoimmune disease and personal history of atopic diseases may also indicate poorer outcomes. [6]
  • The prognosis of tinea capitis is excellent when patients are treated early. However, if left without treatment, patients may develop an abscess known as a kerion. This could lead to permanent hair loss.

References

  1. Ludwig E (1977). "Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex". Br J Dermatol. 97 (3): 247–54. doi:10.1111/j.1365-2133.1977.tb15179.x. PMID 921894.
  2. Levy LL, Emer JJ (2013). "Female pattern alopecia: current perspectives". Int J Womens Health. 5: 541–56. doi:10.2147/IJWH.S49337. PMC 3769411. PMID 24039457.
  3. Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S (2019). "Patients with alopecia areata show signs of insulin resistance". Arch Dermatol Res. 311 (7): 529–533. doi:10.1007/s00403-019-01929-6. PMID 31089876.
  4. Piraccini BM, Alessandrini A (2014). "Androgenetic alopecia". G Ital Dermatol Venereol. 149 (1): 15–24. PMID 24566563.
  5. Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP (2017) Alopecia areata. Nat Rev Dis Primers 3 ():17011. DOI:10.1038/nrdp.2017.11 PMID: 28300084
  6. Madani S, Shapiro J (2000). "Alopecia areata update". J Am Acad Dermatol. 42 (4): 549–66, quiz 567-70. PMID 10727299.