Alopecia areata (Petukhova, 2010) – Is alopecia genetic?

Circular bald patches are typical for alopecia areata.

Nebula Genomics DNA Report for Alopecia

Is alopecia genetic? We created a DNA report based on a study that attempted to answer this question. Below you can see a SAMPLE DNA report. To get your personalized DNA report, purchase our Whole Genome Sequencing!

Sample report on alopecia from Nebula Genomics
Sample variants on alopecia from Nebula Genomics
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What is Genetic Alopecia?

Alopecia is the general scientific term for hair loss when there is no underlying cause such as a skin disease or other internal disorder. The condition affects both men and women, can occur on any part of the body (although it’s most common on the head), and can be either temporary or permanent. 

Genetics, hormone changes, medications, and aging may all play a role in hair loss. Baldness on the scalp is much more common with advanced age and is more common in men than women. A diagnosis can be made based on where and how the hair is being lost. While a number of people choose not to treat this condition, many others do. Cosmetic changes, medications, and even hair transplants can be used to reduce hair loss, if desired. If alopecia is caused by an autoimmune disorder, steroid treatments may be effective.

There are three types of the autoimmune disorder that causes hair loss, characterized by how severe the loss appears: alopecia areata, alopecia totalis, and alopecia universalis.

Bald patches are a common symptom of alopecia areata
Bald patches are a common symptom of alopecia areata. Wikipedia. CC-Attribution 4.0 International. 

Types

There are three types of alopecia areata:

Alopecia areata: a common autoimmune disorder, this form causes hair to fall out in small patches.

Alopecia totalis: An advanced form of alopecia areata, this form of hair loss causes complete loss of scalp hair.

Alopecia universalis: An advanced form of alopecia areata, this form causes complete loss of hair from the scalp and body.

Is Alopecia Genetic?

Alopecia areata is believed to be caused by a combination of genetic and environmental factors. It is expected to be hereditary as it is observed that the risk of developing the condition is greater if a person has a first degree relative with it. However, it is known to be a complex disease in which many genes are involved and is not well understood.

A hair follicule with alopecia areata
A hair follicle attacked by the immune system. Wikipedia. CC-Attribution-Share Alike 4.0 International.

Most of the genetic basis of alopecia areata involves genes identified with the condition play a role in the immune system and several of these genes are part of the human leukocyte antigen (HLA) complex. This complex contributes to the immune system’s ability to distinguish between proteins made by the body and those made from foreign invaders. When genetic variants prevent the complex from doing its job, the body has a greater risk of attacking its own cells.  

People with alopecia areata also tend to have family members with other autoimmune disorders:

Epidemiology

Worldwide, 100-200 of every 100,000 people develop alopecia areata with a lifetime risk of 2%. Alopecia areata affects an estimate of millions of people in the United States.

Out of these millions of Americans, the condition occurs in both adults and childrens and this specific condition appears to affect both males and females of all ethnicities equally. It occurs most often in children and young adults over a period of weeks. It can be an unpredictable disease in that the hair will grow back in most cases but it may fall out again without warning. 

The mean age of diagnosis was 32 years in males and 36 years in females. 

Symptoms of Alopecia

Usually, the first and only sign of alopecia areata is the sudden loss of hair. This hair loss normally occurs on the scalp as a round or oval bald patch. The patches can continue to grow and form one large patch.

Although the scalp is most common, it can also occur with other body hair and in other patterns:

  • Men may experience round patches of hair loss in the beard area
  • While round patches are the most common, there can be other patterns of hair loss
  • Some people develop a band of hair loss on their scalp
  • Widespread hair loss is possible
  • Loss of eyelashes and eyebrows is possible
  • Red nails or brittle nails (this is more common in alopecia universalis)
Symptoms of hair loss in the beard area
Symptoms of hair loss in the beard area. Wikipedia. CC-3.0 Unported.

Other than hair loss, there is no pain or other symptoms of alopecia. Some people report a tingling or itching in the area where the hair will fall out before it actually occurs.  

For some people, the greatest risk to general health is the psychological impact of the disease and low self esteem. The condition is often associated with depression, anxiety, and other mental health disorders.

Causes of Alopecia

Alopecia areata is an autoimmune disease that occurs when your immune system attacks healthy hair follicles in your body. Although the attack will cause hair loss, it does not destroy the follicles. This means that your hair will grow back once the immune reaction subsides.

Cold may be a trigger of the condition as more people report being diagnosed in November and other colder months while the fewest reported cases were in May and August. Other triggers that can increase risk are stress and physical injury.

Some patients with other autoimmune diseases, such as multiple sclerosis and rheumatoid arthritis, also have a vitamin D deficiency. This has prompted research into vitamin D levels in relation to patients with alopecia areata. As of this article, results tend to be inconclusive with some patients showing an association while others do not.

Those with disorders such as type 1 diabetes are also at higher risk.  

Hair loss unrelated to the autoimmune disease may be caused by a number of factors. Family history in which hair loss occurs with aging is the most common cause of baldness. This usually occurs in a predictable pattern in the form of male pattern baldness or female pattern baldness, also called androgenetic alopecia. Physical and emotional shock great enough to cause a large amount of stress has been associated with thinning hair although this hair loss is normally temporary. 

Hormonal changes such as pregnancy, childbirth, or thyroid conditions can also cause either permanent or temporary hair loss. In addition to alopecia areata, other medical conditions such as infections caused by ringworm and trichotillomania (a hair pulling disorder) can cause unexpected hair loss.

Hair loss can be a side effect of certain medications and medical treatment. These include medications for cancer, arthritis, depression, heart problems, gout, and high blood pressure as well as radiation therapy traditionally used to treat forms of cancer. 

Diagnosis of Alopecia

To diagnose the condition, your doctor will probably recommend a physical exam and look at the pattern and amount of hair that is lost. Additional procedures can be used to diagnose underlying health conditions that may be causing hair loss.

A type of balding pattern that can occur
 A type of balding pattern that can occur. Wikipedia. CC-Attribution-Share Alike 4.0 International.

If your doctor suspects an underlying condition, they may recommend a blood test, which can reveal autoimmune disorders like alopecia areata, a scalp biopsy, which can help detect infractions, or light microscopy (examination of the hair on a microscope). The type of test your doctor recommends is largely based on what they may suspect is causing the problem, which may be based on other symptoms. 

If the cause cannot be determined, you may be recommended to a specialist called a dermatologist, who focuses on hair and skin.

Treatment of Alopecia

Some people choose not to treat hair loss and instead let it fall out naturally or shave their heads. In many cases of alopecia areata, the hair will grow back naturally over time and thus doctors do not recommend treatment at points of less than a year. Although there is no cure for alopecia areata, people may be able to find treatments that stop or slow the condition. 

Treatment will largely depend on age as well as extent and location of hair loss.

Treatments for children 10 years and younger

This condition often starts in early childhood. Hair loss and regrowth can be particularly hard emotionally at this age. For these children, corticosteroids applied to the bald spots are usually the first option. This medication is applied 1-2 times per day and helps regrow hair. It is normally very effective. Once corticosteroids are stopped, they may be replaced by another medication called minoxidil that helps maintain hair growth. These medications have few side effects, making them ideal for young patients.

Patchy hair loss

In the case of a few bald spots in patients 10 years and older, similar medications can be used. This is the most common cause for genetic alopecia. Generally, corticosteroid injections into the bald spots are recommended. These are performed at a dermatologist’s office every 4 to 8 weeks. This is considered the most effective treatment. As with children, you will be given minoxidil to help maintain growth. Other topical options are topical corticosteroids and another prescription called anthralin, which may cause skin irritation.

Loss of other hair

If hair in other areas of the body besides scalp hair loss occurs, your doctor may recommend some cosmetic or prescription treatments to keep your body healthy. For example, eyelashes help protect your eyes. If you lose your eyelashes due to this condition, you may be prescribed false eyelashes, glasses, or a medication called bimatoprost (typically prescribed to treat glaucoma) to help regrow eyelashes. Eyebrows can also be important for self-esteem. Loss of eyebrows can be treated with fake eyebrows, semi-permanent tattoos, or medication that stimulates their regrowth, such as corticosteroids.

Substantial hair loss caused by alopecia areata
Substantial hair loss caused by alopecia areata. Wikipedia. CC-Attribution-Share Alike 4.0 International.

Alopecia totalis and alopecia universalis

These subtypes of the condition involve losing lots of hair very quickly from most or all of the body. In these cases, hair regrowth on its own is rare. Your doctor or dermatologist may recommend the following options to improve quality of life if hair loss causes anxiety and self esteem problems:

Contact immunotherapy: This process involves a doctor applying chemicals to the bald areas of your head on a regular basis. This treatment is designed to stop the immune response from attacking the hair follicles in this region. It is given weekly and built up to remain in the affected areas for 48 hours. A rash is expected to occur as it signals that the medication is working. Treatment continues until hair is regrown or it fails to regrow in 6 months.

Methotrexate: This medication is designed to prevent the immune system from reacting and is often used to treat rheumatoid arthritis. It has seen some success, especially when combined with corticosteroid treatment. This medication sometimes has serious side effects so it’s important to consult with a health care professional for medical advice. 

JAK inhibitors: This new type of medication often works for patients when other treatments have failed. It has been shown that regrown hair will fall out if the medication is stopped. Therefore, other variations of this drug are being studied. This treatment was first found to have success in clinical trials at the Irving Medical Center at Columbia University. 

This Is alopecia genetic article is for educational purposes only. It’s important to remember that for those with only a few patches of missing hair, it tends to grow back within one year. For others, treatments are available with the help of a medical professional. 

More information on symptoms, treatment options, and clinical trials can be found at the National Institute of Arthritis and Musculoskeletal and Skin Diseases website and the U.S. National Library of Medicine

You may also be interested in the National Alopecia Areata Foundation website.

If you liked this article, you should check out our other posts in the Nebula Research Library!

You may also be interested in these company reviews that offer products to stop or reduce hair loss:

  • Capillus (laser filled caps to stimulate hair follicles)
  • Keeps (prescription strength hair loss treatment)
  • Nutrafol (supplements for hair growth and thickening)
  • Vegamour (plant-based hair care products)
  • Viviscal (supplements for hair growth and thickening)

November 12, 2021