Doctor, my daughter needs more antibiotics to treat the hair loss. The last doctor did not give her enough, that’s why her hair is falling out again!

— Words of a misinformed mother.

Alopecia means hair loss. This particular type of hair loss is called Alopecia Areata (AA). The condition results in the loss of hair on the scalp and other hair-bearing areas of the body such as eyebrows, face, axilla(armpits), chest and even the groin. AA usually starts with one or more smooth patches of hair loss on the scalp and can progress to total scalp hair loss (Alopecia totalis) or complete body hair loss (Alopecia universalis). Alopecia Areata can occur at any age, including childhood, as in this case. The loss of hair may be associated with pitting of the nails in 10-50 per cent of patients affected with AA . When this condition occurs in children, it is often confused with ringworm of the scalp (tinea capitis). The salient difference between both conditions is that tinea capitis is usually associated with the enlargement of lymph nodes at the base of the scalp with flaky patches of Alopecia with or without pus/sores. Like many other skin conditions, Alpecia Areata often starts after a very stressful event. In the case of a child, one must pay attention to the source of the stress. It may be due to a sudden disruptive event (eg new school, divorce), parents constantly bickering at home, or high expectations from parents on school performance. For teenagers, it is usually exam stress that precedes the event of hair loss. For adults, stress from work or the lack of work, unhappy union, stress from wayward children etc. Alopecia Areata is considered to be one of the autoimmune disorders. The body has an extraordinary defence mechanism (the army of white blood cells) for fighting invading germs that cause infection. Unfortunately, in the case of Alopecia Areata, the body treats its own hair cells as foreign invaders, sending out white blood cells to attack the hair follicles causing hair loss in the affected area. The death of the hair cells is not permanent. Therefore it is possible that while an area is experiencing regrowth, another area can lose hair simultaneously. Sometimes the new hair may regrow grey or white, but after a while the original colour usually returns. Alopecia Areata may develop in more than one member of the family, who may also develop other autoimmune diseases such as vitiligo. The more severe forms of Alopecia Areata are usually associated with hair loss at a young age, andif the initial hair loss is very severe, these individuals may also suffer from atopic eczema or asthma.

Dr Patricia Yap is a dermatologist at Apex Skin Care and Laser Center. E-mail: apexskinclub@gmail.com MANAGEMENT:

• Like most other skin conditions, management is the key. There is no cure for Alopecia Areata. Fortunately, up to 50 per cent of patients will grow back their hair within one year, even without treatment. The million-dollar question is, how do you know which 50 per cent you are in?

• Seek the advice of a dermatologist early to confirm and to help you to manage this condition. The aim is to recover from hair loss as soon as possible.

• A potent topical steroid is usually prescribed to apply to the affected bald patches to promote hair growth.

• Intralesional steroid injections into the area of hair loss at the dermatologist’s office every 6-8 weeks may speed up regrowth of the hair.

• For adult patients who are afraid of injections or young children who are fearful of needles, an irritant solution is applied to the bald patches by the dermatologist to promote growth.

• For extensive hair loss, a combination of the above along with oral steroid pills may be given.

• Minoxidil may be given to maintain hair growth, although the evidence based on this application is sketchy.

• An attractive hairpiece is the best solution to disguise the presence of hair loss while undergoing treatment. For young children, appropriate headgear should be allowed by school authorities until adequate hair growth is achieved to prevent teasing by fellow students.

• Tattooing can be used to disguise the loss of eyebrows and is more convenient and less time-consuming than applying eyebrow pencil daily.

• Some people need to seek professional counselling to manage ongoing stress associated with AA.

• It is very important to find a support group locally or internationally (The National Alopecia Areata Foundation) which serves as a resource for patients, offering advice on living with AA. This forum allows patients to regain self-confidence in order to live a full and productive life.