I have had my share of easy and difficult cases of balding problems and so far, I can only remember two cases of treatment failure. Failure for me means that the patient did complete the treatment, and the hair grew, but only to fall off again while still undergoing treatment. The others I treated with hair transplant due to my eagerness to try the new technique introduced by a colleague, but only to find out after a year that the procedure was being discouraged by foreign hair experts. While the few others who did not grow hair as expected are from the beginning considered as having a poor prognosis due to the severity of balding, length of time of the problem, old age, and type of alopecia. For me, they are not considered failures but just difficult cases.
TJ, a young adult, was suffering from one of the most difficult-to-treat cases of alopecia universalis (AU). When TJ was 15 years old, her mom noticed some bald spots on her scalp. Her mom brought her to a dermatologist and she was diagnosed with alopecia areata. Two years later, all of TJ’s hair fell out in a matter of weeks. This included her eyebrows, eyelashes, body hair, nose hair, everything very typical of AU. TJ was completely bald for six years. But after only three months of topical therapy without injections, I was really amazed at the speed of her recovery — her scalp hair is almost full now and both eyebrows have grown, too, with the left thicker than the right while her eyelashes are starting to peep out from her lids.
Alopecia areata is a hair loss disease that affects women and children. The onset is often sudden, random, and frequently recurrent. Although the disease does not damage a person’s physical health, it can have severe effects on one’s quality of life and emotional health through its impact on confidence and self-esteem. Alopecia affects around 1.7 per cent of the population, with men and women equally affected. About 25 percent of people affected have a family history of the condition. The exact cause of alopecia is not known, although experts generally agree it is a disease of the immune system. There is believed to be a genetic component and in some cases, it is linked to stress. In alopecia, the immune system attacks the affected hair follicles by mistake. That halts hair growth and causes hair to abruptly shed. There are different types of alopecia, ranging in severity. Alopecia universalis is the total loss of hair across the body, while alopecia totalis is loss of hair on the head alone. The vast degree of sufferers will experience some re-growth while some, a complete re-growth.
Alopecia universalis is the rarest and most severe of all the forms of alopecia. It is defined as a nonscarring loss of all body hair, characterized by sudden onset independent of age and sex. It can also damage and distort nails. It is an advanced form of alopecia areata, a condition that causes round patches of hair loss. The cause is unknown. Genetic, environmental, and individual etiologic factors are discussed. Its association with other autoimmune disorders renders it also as an autoimmune pathogenesis (again, that is in which an affected person’s immune system mistakenly attacks the hair follicles) very likely, the targeted antigen being private to the hair follicle. (https://rarediseases.info.nih.gov/gard/614/alopecia-universalis/resources/1 - ref_731) Sufferers of AU have a genetic mutation in their chromosomes. The condition is something that is present from birth, although it may not present itself until later on in life. Normally, sufferers are otherwise healthy, but are more likely than the general population to experience thyroid disease and vitiligo (patchy loss of skin color). Those with vitiligo may eventually develop AU over time. Many individuals with alopecia universalis are born with some hair, but begin losing it very quickly. The disorder is inherited as an autosomal recessive trait. Roughly 20% of affected people have a family member with alopecia, suggesting that genetic factors may contribute to the development of AU. It is difficult to treat, although some sufferers do spontaneously have hair growing back, even years after the onset of the condition. Alopecia universalis may be acute and short-lived or remain permanently. Regrowth is always a possibility, even for those with 100% hair loss over many years. However, it is not possible to predict when regrowth will occur.
The standard method of treatment is topical immunotherapy, which involves producing an allergic reaction with irritants placed onto the skin. Unfortunately, the treatment needs to be sustainable for hair growth to continue and the success rate is around 40%. The theory behind this method is based on the general knowledge that hair can be stimulated into growth sometimes, simply by irritating the follicles. Chemicals such as diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE) are applied to the scalp. About 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment. Treatment must be continued in order to maintain the hair, or until the disease has run its course. There are no good options for long-term treatment of alopecia universalis, but there is this new drug now that promises speedy regrowth.
In the case of TJ, injections were delayed because in my experience, they don’t sit well with cases of extensive alopecia such as universalis and I usually apply them only if all the other medicines fail. All I did was to give topical medications and added a new cream which really worked well for her.
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