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Acanthosis Nigricans
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Hirsutism, excess facial hair can sometimes occur simultaneously with some forms of AA

What is Alopecia Hirsutism?
Hair Removal Treatment
Alopecia Areata May Occurs Simultaneously

Disorders that may be associated with alopecia areata

Hashimoto's Thyroiditis
Insulin Resistance
Metabolic Syndrome (X)
Polycystic Ovarian Syndrome (PCOS)
Type 2 Diabetes
Cushings Syndrome

new glucose revolution for living well with pcos
New Glucose Revolution: Living Well With PCOS:   Dr. Brand-Miller --author of the NY Times bestseller The New Glucose Revolution, the authoritative guide to the glycemic index--along with Dr. Nadir Farid and Kate Marsh, address the root cause of PCOS--insulin resistance.

womans guide to living with pcos  
Collette Harris

A Woman's  Guide to
 Living with PCOS
Author Collette Harris recounts her own battles won with PCOS.

 living with pcos  
Boss, Sterling, Legro
Living With PCOS:  
Named after the cysts that may form in the ovaries, PCOS is a hormone disorder that causes irregular menstrual cycles, obesity, and infertility, among other symptoms. If untreated, it can lead to heart disease, diabetes, and uterine cancer. This is a book about and by PCOS women (coauthors Boss and Sterling both have it; physician Legro is an expert on the syndrome), which is evident in their easy-to-understand descriptions of the disorder, its symptoms, medical diagnosis, and treatments (including. alternative methods) as well as the emotional impact.

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Diabetes Medical Library                        back to main "Problems" page
Problems and Complaints Associated with Diabetes      

Alopecia Areata, Alopecia Totalis, Alopecia Unversalis
Symptoms, Causes, Treatment, and Related Disorders

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What is Alopecia Areata (AA)?
Suspected Causes of Alopecia Areata
Symptoms of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis
Treatment Options for Alopecia
Coping With Alopecia  

Also, see "Hirsutism," excess facial hair.  Hirsutism and AA are not related, however, sometimes occurs simultaneously in carbohydrate metabolic disorders.

What is Alopecia Areata (AA)?

AA is a chronic type of hair loss that can evidence in any area where hair is present, especially on the scalp.  It is a benign condition (causes no harm to the body) but it can be psychologically distressing to persons suffering hair loss from AA.  

Suspected Causes of Alopecia Areata

Currently, the causes of AA are not understood but the most commonly accepted explanation is that it s a T-cell autoimmune disorder that seems likely to have some genetic predisposition involved.  It has also been discovered that many persons with AA also have an increase in antibodies to hair follicles. This means the body sees hair follicles as foreign invaders and follicles are attacked by white blood cells because they must be eliminated from the body. This disrupts the normal hair formation and cycle and follicles become very small; not re-growing hair for months or even years (however, the follicles do not die). Studies show about 90% of persons with AA have these antibodies as compared to only approximately 37% in the general population.

The antibody response affects the anagen phase hair follicles but it is not known if this a cause or side effect of AA but clinical evidence does show that AA is associated with other autoimmune disorders especially those of the thyroid and vitiligo.  That fact that AA affects one in five (according to the NAAF) seems to indicate some genetic issues at play. In fact, AA is most common in families that have other autoimmune disorders including allergies, thyroid disease, lupus, early-onset diabetes and rheumatoid arthritis.

Biopsies of skin in the area affected by AA show the presence of lymphocytes (one of the body's immune system cells) inside the hair follicles.  Since lymphocytes normally are not normally present in hair follicles, this is again, another indication of AA being some sort of autoimmune related disorder.  



Persons with AA may have a family history of other persons being affected.  The rate is estimated to be approximately 10-20% familial affectation, compared to 1.7% in control subjects.  The degree of AA symptoms do not show any pattern in relation to how other family members are affected, but the more severe the problem of AA is, the more common it seems to be in families.

Several genetic studies have been focused on the leukocyte antigen, and specifically leukocyte antigen DQ3 (DQB1*03) has been found in over 80% of those with AA.  Other genes are also being studied and the high association of AA in persons with Down syndrome may be an indication that part of the genetic clues like on chromosome 21.

It appears that AA is probably the result of polygenetic (more than one gene) defects and the role of environmental factors in causing or triggering AA has not been determined.

Some persons with AA complain of itching or pain on the affected areas.  This may indicate there is an underlying problem or aggravation to perifollicular nerves.  One study has also shown evidence of a lower basal blood flow and greater vasodilatation but more studies are needed to understand the significance of these findings.

So far, studies to determine a viral causes have not shown any evidence that AA is viral in nature, although many in the medical community still feel the a virus may somehow be involved.  


Symptoms of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

AA results in loss of scalp hair in smooth, circular patches typically about the size of a coin, which cause bald spots.  With alopecia totalis, the entire scalp hair is lost, and alopecia universalis refers to the entire loss of body hair.  There is also a form of AA in which there is a general overall thinning of hair.  Although hair loss is usually temporary, it can reoccur.

There are varying degrees of affectation in different persons with AA an there is no way to predict how large, or substantial the balding will be, or, how long it will last before normal re-growth can be expected, and, if and when additional episodes of AA will occur.  



Alopecia Areata related statistics:

  • Is present in the general population 0.1 – 0.2% (United States),
  • AA-related problems account for 07. – 3% of dermatological visits,
  • Lifetime risk of developing AA – 1.7%,
  • There is not increase or decrease in the rate of AA based upon racial factors,
  • AA Affects both males and females,
  • Some studies indicate a marginally higher percentage of AA found in women,
  • AA occurs in all ages: birth to old age,
  • Is most common in ages 15-29; as many as 44% have onset prior to 20 years of age,
  • Onset after age 40 is seen in slightly less than 30% of patients,
  • The National Alopecia Areata Foundation (NAAF) reports that 2% of the US population will be affected at some point in their lives (approximately 4.5 million persons).  


Treatment Options for Alopecia

In approximately 50% of persons with AA hair will regrow without any treatment within a one year period.  It is important to note that the longer the hair loss persists, the less likely it is that hair will re-grow.  It is best to see a dermatologist for treatment options early on.

No cure is available for AA or “one size fits all” treatment approach, but there are treatments that may prove to be effective for individual patients. Treatment options include:

  • Injection of cortisone (a steroid) directly into the balding spots.
  • Oral administration of cortisone.  Important note:  Pills are stronger than shots and may carry more side effects.  One side effect of steroid use is the elevation of blood glucose levels.
  • Minoxidil – A topic solution that comes in two strengths 5% for men and 3% for women.  Women should not use the male strength as it can cause facial hair to grow and may make scalp hair loss worse.  Minoxidil is an over-the-counter drug but talk with your doctor before starting minoxidil and be sure to read the warning and instruction label before trying this product.
  • A  widely used cream (or ointment) to treat psoriasis may also be used in treating AA; it can cause skin irritation.
  • Topical Immunotherapy is also used to treat AA.  This involved application of chemicals to the scalp that produces and allergic reaction and may result in re-growth of hair.
  • A study reported in the journal Archives of Dermatology (Vol 134, 1998;1349-52) showed effectiveness of aromatherapy essential oils (cedarwood, lavender, thyme, and rosemary oils) in some patients.

As with many disorders for which there is no clear cut beneficial treatment, a variety of remedies are promoted which in fact have no benefit.

Coping with Alopecia

Hair loss can be traumatic for men and women, and especially to young children.  Counseling and support groups may be needed to help a person cope with lose of scalp hair in particular.  Persons with AA may feel as if they are alone, or helpless, and the uncertainty as to whether hair will re-grow – and when – can be very stressful.

Related Information
Skin Diseases and Conditions
Immune System Glossary


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Page Updated 03/27/2006