Alopecia areata is an autoimmune disease which attacks hair follicles. There is a strong genetic susceptibility to the condition and each year we learn more and more about the genes implicated int he condition. In fact, just last year Dr. Angela Christiano and her research group at Columbia University uncovered eight genes that are strongly implicated in the condition. We now understand that the tendancy to develop alopecia areata may be present at birth, but what actually causes it to "come out" in some people but not in others remains poorly understood.
Patients with alopecia areata are rarely ever candidates for hair transplantation. Hair follicles moved from a normal appearing area of the scalp into a bald area remain susceptible to being attacked by the patient’s immune system. This autoimmune attack can occur 2 months after the transplant or 50 years after a transplant. A previous post reviews hair loss conditions which typically can and can not be treated by hair transplantation
Patients with a small stubborn spots of alopecia areata are advised to seek the advice of a physician knowledgable about hair loss. Patients are typically treated with topical steroids and/or steroids injections. Other treatments such as minoxidil, diphencyprone, anthralin or squaric acid dibutyl ester may be discussed. Oral treatment options may also be discussed in some situations, including use of prednisone, sulfasalazine, methotrexate and cycosporine.
Although some hair transplant surgeons will never perform hair transplantation in a patient with "long standing" alopecia areata, some surgeons have very occasionally had successful outcomes transplanting alopecia areata in such situations. One such study is given below by Dr. Robin Unger's team in New York.
Unger R, Dawoud T and Albaqami R. Successful hair transplantation of recalcitrant alopecia areata of the scalp. Dermatol Surg. 2008 Nov;34(11):1589-94.
If the area affected by alopecia areata is small, and has remained unchanged for several years, and if a scalp biopsy shows no inflammation below the scalp, hair transplantation 'could' be considered. But this would require very thorough discussion which an experienced physician. However, patients need to be aware and accept the risk that that the transplanted hair is susceptible to falling out again - at any time. For these reasons, patients with alopecia areata are rarely ever candidates for hair transplantation.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299