[Click! Health] Alopecia Areata, the Key is Immunological Factors... "Must Recognize as a 'Chronic Disease' to Manage for Life"

Alopecia areata refers to the sudden loss of hair in a circular pattern. It can involve the loss of all scalp hair, as well as hair on the eyebrows, eyelashes, and body hair. Unlike male pattern baldness, which is a type of androgenetic alopecia, alopecia areata presents in various forms ranging from patchy hair loss to total body hair loss.

Mechanism of Alopecia Areata. [Data provided by Gangdong Kyung Hee University Hospital]

Stress is commonly thought to be a cause of alopecia areata. Many people reduce stress and rest, waiting for natural healing while leaving it untreated. However, although stress can be one of the factors influencing alopecia areata, it is difficult to say that stress alone causes or worsens the condition. Professor Yoo Bak-rin of the Department of Dermatology at Gangdong Kyung Hee University Hospital explained, "The most important cause of alopecia areata is immunological factors. Although the exact cause has not yet been identified, for some reason such as a certain stimulus, T cells become activated and mistakenly recognize hair follicles as foreign substances, attacking them and triggering an immune response, which leads to alopecia areata."

Mild alopecia areata usually recovers well with topical steroid treatments. When alopecia areata has occurred for less than one year and there are one or two or fewer alopecic patches, the natural recovery rate is close to 80%. The problem lies with severe alopecia areata, which refers to hair loss exceeding 50% of the total scalp hair. In severe cases, especially among young patients, it can lead to serious issues such as depression. Additionally, less than 10% of alopecia areata patients also have other autoimmune diseases such as thyroid disorders, vitiligo, or atopic dermatitis.

Professor Yoo Bak-rin, Department of Dermatology, Kangdong Kyung Hee University Hospital.

In severe cases, systemic treatment (oral medication) is required in addition to topical ointments. Oral treatments include steroids and immunomodulators, but there are several issues. Some cases of severe alopecia areata are refractory and do not improve with any treatment. Even when hair loss improves, there are concerns about side effects such as increased blood sugar, elevated blood pressure, and weight gain. Furthermore, many cases relapse when the medication is stopped after improvement or when the dosage is reduced or discontinued after long-term use. Treating severe alopecia areata remains challenging.

Fortunately, new drugs have recently been developed. These have somewhat superior efficacy and are safer than existing immunosuppressants. These new drugs are expected to offer new hope for patients with refractory severe alopecia areata. However, alopecia areata is a lifelong condition with frequent relapses, so it should be considered a disease that requires lifelong management even after improvement. Professor Yoo stated, "Alopecia areata is a heavy burden for patients, especially when it occurs at a young age, causing significant mental, social, and economic losses. It definitely requires treatment and is a condition that can be controlled with treatment. Like chronic diseases such as diabetes, hypertension, and atopic dermatitis, it should be managed and controlled with lifelong treatment."