Frequently Asked Questions:

If my doctor is referring me to a dermatologist for a confirmation of a diagnosis of alopecia, are there any tests/ questions I should be asking?

Alopecia areata is a clinical diagnosis the majority of the time.  This means that your dermatologist can make the diagnosis by examining your scalp and obtaining your history.   In rare cases a biopsy may be recommended.  You should ask your dermatologist if he/she thinks screening blood work is necessary to look for associated autoimmune conditions such as hypothyroidism for example.

What treatment options are available for alopecia areata?

Treatment options include topical and intralesional steroids.  When these fail, or hair loss is extensive, then the usual next treatment is contact sensitization with DPCP.  Other topical therapies that are used depending on the patient’s history include anthralin, Protopic, and minoxidil.  Oral treatments that have been used include prednisone, methotrexate and cyclosporine but most patients and physicians prefer to avoid these due to the risk of side effects and a high relapse rate after they are discontinued.

How safe and effective are the treatments for children under the age of 18?

Every treatment has its own side-effect profile and therefore the specific treatment recommended by your dermatologist should be discussed with him/her.  The most common treatment in children is topical steroids and history suggests these are extremely safe when used under the supervision of your dermatologist.  Similarly intralesional steroid injections have been used safely in children for decades.  There is a large amount of misinformation about steroids which is often provided by well-meaning friends, family and pharmacy personnel.

Is alopecia areata hereditary?

There are multiple genes that have been implicated in alopecia areata and there is a hereditary component.  This area is currently not well understood and there may be people in a given family who are susceptible to alopecia areata but never get it.

What is the success rate of the DPCP treatment in males, females, and children?

DPCP stands for diphencyprone.  This is a topical (rub-on) treatment that is done once per week and usually in a hospital or clinic setting. The chemical causes an allergic reaction on the scalp and this can help stimulate hair growth in some individuals with alopecia areata.

DPCP is not recommended for everyone. DPCP may be recommended if an individual has lost more than 50 % of their hair.  It helps regrow hair in about 50-60 % of individuals who have alopecia areata. About one-half of these individuals will experience full regrowth of hair and one-half will experience partial regrowth.

DPCP does not seem to help individuals with alopecia totalis (loss of all scalp hair) and alopecia universalis (loss of all scalp and body hair) to the same extent as those with alopecia areata.  However, about 10 -20 % of individuals with alopecia totalis will still benefit from use of DPCP.   We don’t know exactly what proportion of individuals with alopecia universalis benefit from this treatment, but it is much less.

Children with alopecia areata can also benefit from use of DPCP. In general, about 30-40 % of children will experience some regrowth with use of DPCP. Similar to adults, the treatment works best in children who have not experienced complete loss of their hair.

There has been no significant reported difference in the success of DPCP based on age or sex.  The success rate of DPCP varies widely in the literature anywhere from 5% to 85% depending on the study.  Success rates should be discussed at your local treatment centre.  As with most treatments, the extent of hair loss can affect the success rate.  Remember that not all cases of alopecia areata are the same.  There are many individual differences in alopecia areata and you should not be discouraged because someone you know has failed a treatment you are being prescribed.

What is the success rate of injections?
Like every treatment for alopecia areata, the success rate of intralesional corticosteroid injections varies.  Most patients with one or a few small patches do very well with intralesional treatment.  The larger the area of involvement the less likely injections alone will be successful and other treatments may have to be used in conjunction.  When hair loss involves more than 50% of the scalp area alternate treatment such as DPCP is usually considered since the injections are unlikely to be successful.

I have alopecia universalis and I am concerned about the effect of the sun on my skin.  Am I more susceptible to sun burns or forms of skin cancer?

Individuals with hair loss on the scalp are more susceptible to burns on the head and may be at increased risk for other harmful effects of ultraviolet radiation.

Ultraviolet radiation can cause sun burns and excessive exposure to the sun can lead to certain types of skin cancers. This is particularly true if you have light-coloured skin. Hair helps to block out ultraviolet radiation from the sun and loss of hair leads to more ultraviolet radiation reaching the scalp surface. At present, there is no evidence that individuals with alopecia areata develop a higher rate of skin cancers. However, use of sun protection with wigs, hats, bandanas, sunscreen, and sunglasses is recommended to protect the scalp from sun.

If hair has been lost on certain areas of the arms, you may notice increased sensitivity to the sun in these areas. In general, however, individuals with alopecia totalis are not more sensitive to sun burning on the arms than other individuals. Our sensitivity to the sun may change for many reasons.

I have had alopecia totalis for more than 5 years, is there a chance my hair could grow back?  What would it look & feel like if it did?

Individuals with alopecia totalis or alopecia universalis for more than 2 years are unlikely to grow back their hair.  However, alopecia areata is unpredictable and it’s important to consider many factors.

If the hair did grow back, it might grow back partially or fully.  Those with partial regrowth may notice the presence of strands of thin hair and others might notice the initial regrowth of white hairs.  If hair did grow back fully, it would eventually be very similar in quality and texture as your original hair.

I have just been diagnosed with alopecia areata, I find that I cry a lot and feel sad is this normal?  How long before I will feel like my old self?

It’s normal to feel sad and cry after being diagnosed with alopecia areata. Individuals go through a grieving process which can range in time from a few weeks to 4-8 months.  Everyone is very different when it comes to the emotions they experience after losing hair.

During this grieving process individuals experience a variety of emotions including sadness, depression, hopelessness, guilt, fear, isolation, loneliness, anger, and frustration.
It’s important to get accurate information about alopecia areata as this can helping with coping and with the normal process of grieving. Speak to others who have alopecia areata. Join a support group.  Speak to your doctor to get accurate information about treatments.

If you don’t feel back to your usual self after a few months or if you find that your feelings of sadness are affecting how you function at work, at school, or at home, speak to your doctor about other ways to get help.

My mother and I have alopecia totalis, what are the chances that my children will inherit the disease?

There is a 20-30 % chance that your children will inherit the condition. If you look at it another way, there is a much better chance that your children will not develop alopecia areata.

We don’t understand exactly what causes alopecia areata, but we do know that genetics has an important role. However, most individuals with alopecia areata do not have anyone else in their family affected with this condition. In fact, only 1 out of every 5 people with alopecia areata will have another family member affected.

Kid’s Club Question:
If you have a brother or sister with alopecia can you get it too?
We know that alopecia areata can sometimes run in families. However, most of the time only one member of the family is affected and the other brothers and sisters don’t develop alopecia areata.
Does it hurt to lose your hair?
It does not usually hurt when the hair falls out. However, sometimes there can be a small amount of itching in the areas where the hair loss occurs.
Is there a cure?
There is no cure for alopecia areata yet.  However, research is being done around the world to find a cure. Even though there is no cure, there are several treatments which can sometimes be helpful. Your doctor will tell you about treatments that could be helpful for you.

Will my hair grow back?
If you have a small area of hair loss, it’s quite likely that your hair will grow back. It can be more difficult to get the hair to grow back if you have lost all the hair on the scalp.
There are several treatments for alopecia. You might want to speak to your doctor to see if one of these treatments could help your hair to grow back.
If you have a Question to Ask the Doctor, please email your question to  HYPERLINK mailto:info@canaaf.org. Please put “Ask the Dr” in the subject line. We will do our best to answer these questions regularly.