Alopecia natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD

Overview

The severity and progression of alopecia are dependent on the cause. Patients with alopecia are at increased risk of psychosocial complications such as anxiety and depression. In addition, these patients need to be evaluated for other medical conditions. Outcomes vary with the type of alopecia.

Alopecia natural history, complications and prognosis

Natural History

The progression of alopecia depends on the type of alopecia an individual has. In some cases, it is irreversible as in alopecia mucinosa, alopecia neoplastica, and long-standing cases of tinea capitis. In other cases, it is reversible such as in anagen effluvium. In males with androgenetic alopecia, the hairline regression occurs mostly at the temporal areas bilaterally and vertex balding is also seen. In females with androgenetic alopecia, the frontal hairline is largely unaffected while in other areas, there is hair thinning [1] [2]. In telogen effluvium, it could take as much as 6 months for hair to begin growing again, and it often takes more time for the hair growth to be perceptible to the patient.

Complications

  • In general, people with alopecia are at a greater risk of developing socio-psychological problems such as anxiety and [[depression as a result of hair loss.
  • Other than progressive disease, complications of alopecia areata are inherent to the treatment of choice. However, a study revealed that alopecia areata may be associated with a greater risk of development of insulin resistance. [3]
  • Tinea capitis can lead to irreversible hair loss if untreated, ridicule, and psychosocial impairment in children.
  • If alopecia is secondary to another disease such as hypothyroidism, syphilis, Cushing syndrome, malnutrition or systemic lupus erythematosus, complications would be the same as the underlying disease.

Prognosis

  • In telogen effluvium, recovery is usually good.
  • Androgenetic alopecia is a progressive disease that tends to worsen with time. [4]
  • In the majority of anagen effluvium cases, cessation of chemotherapy often leads to hair regrowth. However, it could take up as much as a few years to achieve a full recovery of hair. Less commonly, full recovery does not occur.
  • In alopecia areata, about 34–50% of patients will recover spontaneously in 1 year or less with majority of them having recurring episodes of alopecia. Progression alopecia totalis or alopecia universalis occurs in 14–25% of patients and of those patients, complete recovery is seen in less than 10% of cases. The degree of hair loss and age of the patient at initial diagnosis may play a role in the outcome of the disease, with onset in childhood being associated with a poorer prognosis compared to a later age. [5] Patients with a positive family history of alopecia areata, presence of accompanying autoimmune disease and personal history of atopic diseases may also indicate poorer outcomes. [6]
  • The prognosis of tinea capitis is excellent when patients are treated early. However, if left without treatment, patients may develop an abscess known as a kerion. This could lead to permanent hair loss.

References

  1. Ludwig E (1977). "Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex". Br J Dermatol. 97 (3): 247–54. doi:10.1111/j.1365-2133.1977.tb15179.x. PMID 921894.
  2. Levy LL, Emer JJ (2013). "Female pattern alopecia: current perspectives". Int J Womens Health. 5: 541–56. doi:10.2147/IJWH.S49337. PMC 3769411. PMID 24039457.
  3. Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S (2019). "Patients with alopecia areata show signs of insulin resistance". Arch Dermatol Res. 311 (7): 529–533. doi:10.1007/s00403-019-01929-6. PMID 31089876.
  4. Piraccini BM, Alessandrini A (2014). "Androgenetic alopecia". G Ital Dermatol Venereol. 149 (1): 15–24. PMID 24566563.
  5. Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP (2017) Alopecia areata. Nat Rev Dis Primers 3 ():17011. DOI:10.1038/nrdp.2017.11 PMID: 28300084
  6. Madani S, Shapiro J (2000). "Alopecia areata update". J Am Acad Dermatol. 42 (4): 549–66, quiz 567-70. PMID 10727299.