1. What is Alopecia Areata?
Alopecia Areata, in ancient times called Area Celsi, is a relatively unknown disease that manifests itself in various forms and can develop erratically with hairless patches up to the loss of all body hairs.
The term Alopecia derives from the Greek alopex which means fox. This animal is in fact known for losing its hairs/fur in patches in autumn and spring. The terms areata and celsi are to identify the loss of hairs in patches or over ball-shaped areas typical of this disease.

2. Who is affected?
Incidence and prevalence are not known with precision. It has been estimated that AA affects 2% of the population (145 million people around the world) independently of gender, skin colour, eating habits and hygienic and personal behaviours. It may occur at any age from the first few months of life and it is more frequent between the ages of 20 and 40 years-old.

3. What causes it?

Alopecia Areata is a genetic and autoimmune disease. Its genetic origin was confirmed by a study done by a team of researchers from the Columbia University Medical Center. By using the case history from the National Registry of Alopecia Areata they were able to identify 8 genes that contribute to AA and one of which has a possible role in the emergence of this disease. From this recent discovery it would appear that many genes associated with Alopecia Areata have also been attributed to other autoimmune diseases such as rheumatoid arthritis, type 1 diabetes and celiac disease all autoimmune diseases from pre-existing treatments. AA pathogenesis is indeed a autoimmune disease, even if the triggering factors are still unclear. This theory would be validated by the temporary regression of symptomatology with high doses of cortisones.

4. How does it development?
It may have an acute trend and cases of relapse are common. In the less serious cases, which are the majority, few bald patches emerge that disappear after a few months without any therapy. In more serious cases loss of hair can occur suddenly over a period of one or two months and in extreme ones in a couple of days.

5. In which forms can it manifest itself?
Different forms may be identified depending on the vastness of the area affected:
AA – Alopecia Areata
TA – Total Alopecia Areata
UA – Universal Alopecia Areata.
Alopecia Areata appears with single or multiple ball-shaped bald patches. In some cases the interested areas become stable, at times they may spontaneously regress or evolve into Total Alopecia Aretata. This is when the loss of hair involves the entire scalp or with Universal Alopecia Areata when the entire skin surface is affected (hair and body hairs). In some cases nails may also be affected. These last two types are to be considered as rare even if the Italian National Health System has not acknowledged them as such. In some cases Alopecia Areata may emerge with a widespread loss of hair without its typical patches (Alopecia Areata Incognita).

6. What’s the difference between Alopecia Areata and baldness?
Alopecia Areata is different from common baldness, also known as androgenetic or seborrheic alopecia, due to its dependency on androgynous hormones. This type of alopecia begins during puberty or later and develops more or less rapidly. It is more frequent amongst men but it may also be observed in women.

7. Is it contagious?
Alopecia Areata is not contagious. It may affect more members of the same family as there is a hereditary predisposition of becoming ill.

8. Can it be caused by stress?
No, there is no scientific proof that stress can cause Alopecia Areata on the other hand it is hair loss that undeniably represents a stress factor of major importance.
Psychological, environmental and family factors may in some cases influence its emergence and development but cannot cause it. Moreover, it would seem that a key role in modulating susceptibility to the disease can be attributed to low social support and individual differences of variables connected with emotional adjustment such as Alexythimia and insecurities attributed with attachment.

9. How can it be treated?
There is currently no effective cure for Alopecia Areata. Its treatment may result to be very difficult as in the majority of cases it is difficult to establish whether regrowth is drug induced or spontaneous. Some treatments are able to induce hair growth but none cure the problem. Unfortunately there are no controlled studies present in the literature that compare different treatments on a homogeneous group of patients.
Psychological support can result in being fundamental in bettering the quality of life of the person affected and their family members.

10. What are the psychological aspects involved?
The psychological impact of Alopecia Areata is very often traumatic. Hair loss emerges suddenly in a person’s life and this generates a painful rapture that opens up life scenarios previously unexplored: a facial and self-image change. There is a transformation of the relationship with one’s own body and interpersonal relationships from the most intimate to social and working ones. These produce a suspension from life’s rhythm that mixes-up the contours in terms of meaning and security by modifying continuity as well as time and relational perspectives.
The loss of a part of the body and/or of one of its functions produces a significant change in one’s self and body image. A profound wound that causes a life of anxiety and pain similar to the experience of grief. The psychological discouragement is worsened by the lack of definite answers from not knowing if and when the hair will grow back. This produces a reduction in self-esteem in terms of self-efficiency and trust which are fundamental resources in embarking on a path of self-acceptance and needed life transformation.

Francesca Fadda Psychologist

Translation by Francesca Avanzini

Bibliography
Bianco M., 2011. A testa scalza. La capigliatura tra presenze e assenze. C.G. Edizioni Medico Scientifiche
Fischer Gustave-Nicolas. Trattato di psicologia della salute. Borla, 2002
Leigheb G., 1995. Testo e Atlante di dermatologia. Edimes
Murphy-Melas E., 2002. La ragazza senza capelli. Health Press (Traduzione e stampa a cura di ASAA – Associazione Sostegno Alopecia Areata).
Rutelli P., 2007. Qualità e sanità: un dialogo per l’umanizzazione. Franco Angeli
http://www.sosalopeciaareata.org
http://www.orpha.net
http://www.antonellatosti.it
Photographic material obtained at http://www.alopeciaworld.com/