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Suggest Treatment For Alopecia Areata

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Posted on Sat, 21 Jun 2014
Question: I was diagnosed with Alopecia Areata around 4 months ago, and it begin with a small bald patch about the size of 2p coin at the top right of my forehead, since then it has developed to be the size of about 2 x2p coins and a 1p coin, I then began to lose a lot of hair above my right ear, which is now very large and almost all of the hair under the right side has fallen out. I have another bald patch about the side of 2x 2p coins on the left in the middle of the side above my ear, and some hair loss above that ear too. I also have a small patch appearing on my middle parting at the very top of my head, about the size of a 5p coin, and next to it, another on the right side about the size of a 2p coin. My most recent patch has developed to the left of the original patch and is about the size of a 2p coin currently. I also have a bald patch on my pubic hair about the size of a 2p coin. I also become tired a lot, and almost always have a cold or some other illness which has gotten me into trouble at work lately, and I am wondering if the two are linked? The hair is still falling out rapidly and I often have to remove the hair from the hairbrush mid way through brushing. My consultant, whom I saw privately, went through all the details and told me I would just have to continue with watchful waiting until summer, which it is now. He said by summer if it wasnt starting to grow back, or was still falling out he would have to look into other options. I would like more information and some brutal truth as to whether the hair has a reasonable chance of growing back, as I was told that there is a small chance it won't, and I am growing increasingly worried as the loss does not seem to be slowing. There is also no regrowth, and the patches are now entirely smooth.

I will attach some images of some the patches as they are now. I have also had blood tests and was told that they came back clear. I believe I am a healthy individual with a well balanced diet, I am just under 5'6, female, just turned 18 3 weeks ago and weigh 109lbs, and I am also active.
doctor
Answered by Dr. Souvik Adhikari (1 hour later)
Brief Answer:
Alopecia Areata

Detailed Answer:
Hello,

Your photographs look extremely distressing but the final diagnosis would be alopecia areata and not alopecia universalis. Since you have pubic hair involvement also, this is a multifocal alopecia areata.
From your pictures I can say that since the extent of scalp involvement is less than 40% in all probabilities the hair should grow back even though the involved area is completely smooth at present. However, since the disease is an autoimmune one there can be no prediction when you would actually see your hair reappear! Also, this condition can recur and these episodes of hair loss and regrowth can occur the frequency of which varies amongst patients.
Regarding treatment, watchful waiting is an option but you can also use topical minoxidil and corticosteroids as well as intralesional ones. However, I must say that whether these would act in restoration of hair is not known as the effects are unpredictable.
Finally, I would like to say that from your pictures, your hair should grow back but again the time frame cannot be predicted. I understand it is absolutely distressing therefore you should wear a wig till complete hair restoration occurs.

Wish you all the very best!
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Souvik Adhikari (21 minutes later)
Thank you for your fast response. I will look into the treatments that you have suggested and then discuss them with my consultant over the phone to see which one he would suggest would be best for me (another face to face consultation is not an option right now as they cost £300 a pop).
I was also wondering if my alopecia is connected to me being tired all of the time as I get 8-10 hours sleep every night, yet feel the need to nap throughout the day. I also have been becoming ill often. I have also lost a lot of motivation to do things and I cry a lot of the time when I look at myself (I used to be quite confident and now I wont even go out - I spend about 20 hours a day in my bedroom and a couple of hours in our home gym) And then 6 hours twice a week I have to go to work, but otherwise I don't want to leave the house (I used to have a great social life). I have been offered counselling, do you think that I may be developing depression from my condition?
doctor
Answered by Dr. Souvik Adhikari (24 minutes later)
Brief Answer:
Alopecia

Detailed Answer:
Hello,

I absolutely understand your condition. The tiredness and loss of motivation are emanating from the underlying condition which is really triggering symptoms of depression. These are not associated with your hair loss in any way as this is an autoimmune condition as I have mentioned already.
Spice up your life, use a wig and socialize!! It's no use confining yourself at home. If you start losing confidence now, you would never gain it back even when the hair grows back with time!
Lastly, I would like to say that it is very easy to say these on my part but I absolutely understand how difficult it is for you. However, you should compose yourself back and be positive because that is the best you can do; let your body do the rest!
Best wishes!!
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Souvik Adhikari (6 minutes later)
Thank you for your reply again :) So the tiredness and lack of motivation is coming from possible depression? Should I go to my family doctor regarding this? I have one more question, and it is about the use of wigs. What type of wig would you recommend, and where could I purchase one? Also, I understand human hair wigs are extremely expensive, are there alternatives I could still heat style? Or any companies I could go to for help with the funding of a wig? If I was to purchase a wig I would want it to look 100% natural and be of a high quality, and I have discussed this option with my mum.
You have been very helpful, thank you :)
doctor
Answered by Dr. Souvik Adhikari (14 hours later)
Brief Answer:
Alopecia

Detailed Answer:
Hello,

Sorry for the late reply. Yes, you can consult your family doctor for the depression issue. Regarding the wig issue, I prefer human hair wigs as their appearance is the most natural. If you are sensitive to human hair you may then opt for synthetic wigs. Here are websites which provide good wigs:

http://www.jennyshairsense.com/humanhairwigs.html

http://www.annabelleswigs.co.uk/
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Souvik Adhikari

Cosmetic & Plastic Surgeon

Practicing since :2000

Answered : 249 Questions

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Suggest Treatment For Alopecia Areata

Brief Answer: Alopecia Areata Detailed Answer: Hello, Your photographs look extremely distressing but the final diagnosis would be alopecia areata and not alopecia universalis. Since you have pubic hair involvement also, this is a multifocal alopecia areata. From your pictures I can say that since the extent of scalp involvement is less than 40% in all probabilities the hair should grow back even though the involved area is completely smooth at present. However, since the disease is an autoimmune one there can be no prediction when you would actually see your hair reappear! Also, this condition can recur and these episodes of hair loss and regrowth can occur the frequency of which varies amongst patients. Regarding treatment, watchful waiting is an option but you can also use topical minoxidil and corticosteroids as well as intralesional ones. However, I must say that whether these would act in restoration of hair is not known as the effects are unpredictable. Finally, I would like to say that from your pictures, your hair should grow back but again the time frame cannot be predicted. I understand it is absolutely distressing therefore you should wear a wig till complete hair restoration occurs. Wish you all the very best!