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Hair Loss/Alopecia Areata

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Question
Dr. Fisher,

I have experienced in the last 2 weeks loss of facial hair in dime sized patches on my chin and throughout the left side of my face. The mustache area has not been affected. I have read a little on line and read that stress could be a possible factor. I did have hair transplant surgery on my scalp 3 weeks ago and received 2100 grafts. I noticed the facial hair loss within a week, but I don't know if there is any connection. I called the Dr who did the hair transplants and she was familiar with AA but said she was unaware of any connection to hair transplants. I just find the timing to be strange that this happened within such a short period afterwords. Is there any chance that my body is responding to follicles in a new place by loss of hair in another area? It sounds like a stretch, but again the timing seems strange. Thanks for any input on this situation.
Craig

Answer
Alopecia areata is a condition that causes round patches of hair loss. It can lead to total hair loss.
Causes, incidence, and risk factors

The cause of alopecia areata is unknown. About 1 in 5 people with this condition have a family history of alopecia.

Alopecia areata is thought to be an autoimmune condition. This occurs when the immune system mistakenly attacks and destroys healthy body tissue.

Alopecia areata is seen in men, women, and children. In a few people, hair loss may occur after a major life event such as an illness, pregnancy, or trauma.

Forms of alopecia include:

Alopecia areata -- patches of hair loss
Alopecia totalis -- complete loss of scalp hair
Alopecia universalis -- total loss of all body hair


Symptoms

Hair loss is usually the only symptom. A few people may also feel a burning sensation or itching.

Alopecia areata usually begins as one to two patches of hair loss. Hair loss, is most often seen on the scalp. It may also occur in the beard, eyebrows, and arms or legs in some people.

Patches where hair has fallen out are smooth and round in shape. They may be peach-colored. Hairs that look like exclamation points are sometimes seen at the edges of a bald patch.

Loss of all scalp hair (alopecia totalis), often within 6 months after symptoms first start.
Loss of all scalp and body hair (alopecia universalis).
Signs and tests

A scalp biopsy may be done. Several blood tests may also be done to check for autoimmune conditions and thyroid problems.

Treatment

If hair loss is not widespread, the hair will often regrow in a few months without treatment.

Even for more severe hair loss, it is not clear how much treatment can help change the course of the condition.

Common treatments may include:

Steroid injection under the skin surface
Medicines applied to the skin including corticosteroids, immunotherapy, and minoxidil
Ultraviolet light therapy
Wigs may be used to hide areas of hair loss.

Expectations (prognosis)

Full recovery of hair is common.

However, some people may have a poorer outcome, including those with:

Alopecia areata that starts at a young age
Eczema (atopic dermatitis)
Long-term alopecia
Widespread or complete loss of scalp or body hair
Complications  

Hair Loss

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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