GENERAL

Question 1: What does the term alopecia come from?
Answer 1: It's from the Greek alopekia which means "fox".

Question 2: If my child has lost all his hair except his upper eyelashes two different times, what is this called? And also I'd like you if you would expand and give us the real definitions for alopecia areata, totalis and universalis, and also possibly, I'm going to give you a little bit more here, if you could also tell us the difference between alopecia areata and its many forms and androgenetic alopecia.
Answer 2: Now, alopecia areata differs from androgenetic alopecia. Generally male pattern hair loss starts out in the front, usually bi-temporal. In women it looks different. It can be bi-temporal but more commonly they thin in the front and they thin in the back and fortunately women don't get the same degree of complete hair loss. Usually they just get thinning in the front and thinning in the back. This is actually very normal for women. When they're in their 50s they start to notice some. Alopecia areata can sometimes mimic androgenetic alopecia but as you know tends to cause very complete hair loss, very smooth hair loss. It starts off often but not always in round patches. And androgenetic alopecia can sometimes progress rapidly. It's not a linear disease as it previously was, but as you know it usually doesn't progress the way alopecia areata can. Regarding terminology, this classic terminology is that patches of hair loss in the scalp is called alopecia areata. If you lose all the hair on the scalp that's classically alopecia totalis; all the hair on the body would be alopecia universalis. Now if you lose all your hair on the scalp and one eyebrow, it's obviously a bit more than alopecia totalis. I think it's just nomenclature, it's not really critical what you call it, you know what you have. There are real biological differences however between those people who get patchy hair loss and the people with alopecia universalis. First of all the more extensive the hair loss the worse the prognosis. Second, there seems to be something different biologically between people who get patchy hair loss and people who lose all their hair. I'm not an expert on the genetics but those genetic studies that have been done showed different genetic associations between the patchy alopecia areata and the alopecia universalis. In fact it was reported at the World Congress of Dermatology in Paris just two weeks ago that there is a gene found in some patients with alopecia universalis which is associated with that condition. So at least a sub-population of patients with alopecia universalis have a gene that's now been identified. Very interestingly, this gene is on chromosome 21. The reason that is interesting is because with Down's syndrome have a very high incidence of alopecia areata; approximately 10%. Down's syndrome is trisomy chromosome 21; there are three copies of 21, and this gene that they found associated with universalis is on chromosome 21, near the area on 21 which seems to be most critical for Down's syndrome. And this particular gene is also associated with other auto-immune diseases. So there apparently are biological differences between alopecia universalis and patchy alopecia, and these biological differences are more than the obvious extent of the disease.

Question 3: Are the number of cases of alopecia areata increasing?
Answer 3: I have no reason to think that there are more patients with alopecia areata today than there ever were.

Question 4: What are the chances of alopecia areata developing into totalis or universalis?
Answer 4: I don't know the exact number. I think in general in alopecia areata the figure is about 2-3% develop totalis or universalis.

Question 5: If alopecia areata gets so severe that it can't be hidden anymore and a prosthesis is needed, will wearing the prosthesis prevent the hair re-growth?
Answer 5: A cranial prosthesis will not prevent anything, a cranial prosthesis really has no relevance. It's a great way to hide your problem, it will not prevent any hair regrowth at all because the problem, it's underneath the skin. It's at the level of the bulb so a hair prosthesis is irrelevant.

Question 6: On a cellular level, is the body reacting the same way with alopecia areata, totalis and universalis, and what are the cellular differences?
Answer 6: At the level of the t-lymphocytes that I was talking about we do not yet know if there is any difference. We haven't identified that there's any difference in the antigen but we haven't really broken it down and looked at it. The only difference that I could remark about are these genetic studies showing that there seems to be a genetic difference between alopecia universalis and alopecia areata in its milder forms.

Question 7: Is it possible for alopecia areata to just go away on its own?
Answer 7: Yes. Actually this ability of alopecia areata to turn itself on and off is so pronounced that it makes doing studies with new treatments very challenging because you have to be sure you either have a control group or treat only half the scalp so you have the other half of the scalp as a control, to try and get over the fact that alopecia areata can flip flop very frequently on its own and even patients who have had universalis can reverse. In fact one of the things I was going to do was just ask if any of you have ever had for any length of time in your life an episode of totalis and universalis, and has it ever regrown? I'm not saying permanently, but has it ever regrown. Would you put up your hands if you've ever had totalis or universalis and had it regrow, whether it fell out again or not? Yes. So I think it's important for all of you to know that. And I stress to my patients, I'm the eternal optimist and I say I can never say to someone that your very extensive alopecia areata or totalis or universalis won't revert, won't regrow. I think that's very important.