Most people who have alopecia areata will only experience a few small to medium sized patches of hair loss on their scalp. This definition is the most common interpretation of alopecia areata. However there is a small minority of patients with alopecia areata who do progress to other forms of it. Alopecia areata is a hair loss disorder that is very unpredictable in its prognosis. The pattern of hair loss can potentially take many different paths. But progressing to these other forms of the disease is rare, and should not be expected by people who have regular alopecia areata.
Alopecia areata can be of many types depending on the intensity of the condition. The two main groups of alopecia areata can be classified as monolocularis and multilocularis. A bald patch in only one area or spot is known as alopecia areata monolocularis whereas multiple areas of lost hair are known as alopecia areata multilocularis.
The treatment of alopecia areata is also classified into two categories. Those with less than 50% scalp hair loss and those who have more than 50% scalp hair loss. The reason for this classification is to judge the severity of the alopecia and the type of treatment to use. For example corticosteroid injection treatments are not generally used on people who have greater than 50% scalp hair loss, instead systemic oral corticosteroids or a topical solution can be more appropriate. Studies have also indicated that those who have less than 50% scalp hair loss can be treated with greater ease than those who have more than 50% scalp hair loss.
Alopecia areata totalis
Alopecia areata totalis is commonly referred to as simply alopecia totalis. It is one of the rarer and extreme forms of alopecia areata. Alopecia totalis is the loss of all hair on the scalp. The whole scalp is affected and there is 100% hair loss which leads to a bald head. Alopecia totalis involves the rapid loss of hair and can occur at any stage in life. Alopecia totalis is usually treated through steroid injections into the scalp of the person. Of people who are diagnosed with alopecia areata, roughly 2 – 7% of them will likely progress to alopecia totalis.
Alopecia areata universalis
Alopecia universalis is the most severe form of alopecia areata in which there is 100 % body hair loss. Alopecia areata universalis involves the complete loss of hair all over the body. Usually the hair loss is rapid and can occur at an any age, rendering the patient as completely hairless throughout the body. The condition affects less than 1% of persons with alopecia areata. Alopecia areata universalis is also commonly known as alopecia universalis or just “AU” for short.
Treatment for AU is often done through immune suppressive treatments. Immunal suppressive treatments should be closely monitored by a physician, as it involves a reduction in the response of the immune system. This type of treatment has been used in the past to suppress the immune system of patients who have undergone a bone marrow transplant, to treat other autoimmune disorders, and to prevent the body from rejecting an organ transplant. However immunosuppression can automatically occur as an adverse reaction to other types of medical treatments or from another disease. In the case of treating AU, the treatment involves creating a controlled state of immunosuppression, where the body’s immune system will not attack the body’s hair follicles, therefore causing a regeneration in hair growth. Though this treatment option does not always work, it has proven to be effective in the treatment of alopecia areata universalis in the past.
Steroid injections are also used to treat AU. But due to the sheer scale of hair loss, injections may not always be the most practical solution. Patients with alopecia universalis have the lowest probability of permanent hair re-growth. Episodes of hair regeneration can occur but they are often followed by a repeat in hair loss in the future.
Alopecia areata barbae
Alopecia areata barbae occurs in men. It is the rapid loss of hair around the beard area. Like other forms of alopecia areata, a small patch of baldness will appear (in the case of alopecia barbae it is the beard area), and then expand from there on out. The final outcome is usually a patchy beard. The patches of hair loss usually start occurring around the chin area, and/or neck areas. Although this is the common pattern for the initial appearance of alopecia areata barbae, it is important to note that this pattern of hair loss may not always hold true for all cases of alopecia areata barbae. Studies point out that roughtly 33% of men with alopecia areata, have it on their beard areas.
Alopecia areata diffusion
Alopecia areata diffusion refers to multiple hairless patches on the scalp. The patches of hair loss are more diffusely spread across the scalp. Often alopecia areata diffusion starts out with one small single patch of hair loss on the scalp. The patch will either enlarge or regress. If the patch enlarges, there is a possibility that another patch will form elsewhere on the scalp. This process may be in a continuous fashion, where hair loss is seen in one region and re-growth in the other and may last for several months or even years. When this occurs, the alopecia areata is now in a diffused state. Hence the name alopecia areata diffusion
Alopecia areata ophiasis
Alopecia areata ophiasis is a particular pattern of hair loss on the scalp. It is hair loss around the sides of the scalp, sparing the top of the head from any hair loss. Hair loss mainly occurs around the temporal regions and/or the occipital regions (back of head). The loss of hair around these locations makes the disorder even harder to treat.
Perinevoid alopecia areata
This is an unusual form of alopecia areata, where hair loss occurs around spots of the skin where the color is different from that of the surrounding skin. These areas of hair loss occur in areas known as pigmented nevi. Pigmented nevi most commonly refers to moles on the skin.