The first signs of alopecia areata can be indicated through small bald patches on the scalp, beard, or any other hair growing part of the body. The bald spots are often round in shape and the skin exposed is usually soft and completely hairless. The loss of the hair is usually sudden. Physicians try and diagnose alopecia through a process of elimination. At the moment there are no scientific ways to diagnose alopecia areata. But for the most part, medical/scientific testing is not needed for the diagnosis of it.
Excalmation hairs around the effected area
A diagnosing indicator of alopecia areata is the ease of removal of hair along the edges of the balding spot or spots. Theses hairs are called excalmation hairs. Hair follicles tend to pull out with greater ease around bald spots, when comparing the strength needed to pull out healthy hair follicles. These fragile hairs would eventually fall out naturally as the condition progresses, regardless of whether or not the outlying fragile hairs were pulled out or not. The hairs are to be examined under a magnification lens. The excalmation hairs should be more thinner moving towards the root of the hair follicle, thus looking like an excalmation point. This method of diagnosis is one of the most common and easiest ways of diagnosing the dieases.
Suddenness of hair loss
Another way of helping to diagnose alopecia areata is to measure the time it took for the hair follicles to fall out. Alopecia areata is a sudden condition. It will usually start with one little patch of hairlessness, and quickly expand from there on out. Physicians can identify alopecia areata if the patient notices the bald patch within a couple weeks. Unlike androgenic alopecia (also known as male/female pattern baldness), alopecia areata is not a gradual hair loss condition. It is sudden and can form on any random area of the scalp or body the bears hair.
Changes in nails
Human nails have been found to be a good indicator of immunal health, in respect to a variety of dieases. Abnormalities such as discoloration, brittleness, receded lunula, clubbing (nail is convex towards the center), grooves, white spots, thickening and thining among other changes can indicate an illness in the body. The abnormalities of the nails can occur either before, during or after episodes of an illness. Nails are made of a protein caled keratin. Keratin is also a protein found in hair follicles. The close relationship between hair and nails has led to some theories of using the appearnce of the nails to diagnose alopecia areata.
People with alopecia areata can also have nail abnormalities. Physicians will try and use the conditions of the nails to try and judge the severity of the alopecia. For example, marked nails could indicate that alopecia areata totalis or universalis. Generally the more severe the hair loss, the greater the possibility of having aberrant nail formation. It has been noted that anywhere from 10% to 66% (from different studies) of alopecia areata patients have some form of abnormalities in their nails that has coinsided with occurances of alopecia areata. Given this large interval of probabilities we cannot conclude that this alone can disgnose alopecia areata.Changes in the nails is not an exclusive symptom of alopecia areata but can help determine if the bodies immune system is not funtioning properly.
Skin and hair biopsy
For more accurate diagnosis, more advanced and science based tests are available. The first of which is conducting a skin biopsy. Where a dermatologist takes a small piece of skin from the effected region and examines this tiny piece of skin under a microscope. What is looked for in the sample, is whether or not there is focal inflamation present in the roots of the hair follicles. Physicians can also examine the effected hairs themselves under microscopic examination. An abnormality growth pattern of the hair follicles can indicate an immunal attack on the bodies hair follicels. Anagen hair follices that have shown regressive changes in the hair bulbs have been found to be a strong indicatorof alopecia areata.
Rule out other causes of hair loss
Furthermore physicians will inspect the effected areas for scars, burns or cuts. This is done in order to confirm that the loss of hair was not due to a burn, sharp instrument damaging the skin, or any other form of skin damage. The area thought to be effected by alopecia areata, should not have any of these marks of physical trauma. If these marks are present then the hair loss could be due to damaged skin cells. The hair loss process in alopecia areata is painless. The patient would not typically have noticed hair falling out.
Sometimes alopecia areata can be mistakenly diagnosed for another dieases. This is especially possible for the more rare forms of the dieases such as alopecia totalis and alopecia universalis. One common misdiagnosis is the diagnosis of alopecia areata totalis while in reality it is a rare dieases called atrichia with papular lesions. Atrichia with papular lesions affects babies and children. Is a very rare dieases where loss of hair occurs soon after child birth followed by a diffuse papular rash during childhood. The cause of this disorder is a consequence of the deleterious mutation in the human hairless gene during infancy. Atrichia with papular lesions will result in the total loss of hair on the scalp, closely resembling alpecia totalis. It is believed that less than 1% of alopecia totalis cases are actually cases of Atrichia with papular lesions.
Other forms of hair loss can also be mistakenly diagnosed as alopecia areata. For example pregnancy related hair loss can often be misinterpreted as alopecia areata. Similarily stressors on the body, such as emotional or physical stress, can cause hair on the scalp to fall out. Although stressors are believed to help trigger alopecia areata, in most cases, it may no be due to an autoimmune response of the body. To be sure that the cause of hair loss is due to an autoimmune reation, it would be advised to conduct a variety of diagnostic tests by a physician that could confirm an adverse reaction of the immunesystem triggered spots of hair loss.