Tuesday, June 20, 2006

Treatment of Alopecia Areata

Prof Madiraju V Subramanyam

Unfortunately there is not yet any reliable cure for alopecia areata. Luckily the hair usually grows back slowly by itself. Sometimes the new hair may regrow grey or white, but after a while the original colour usually returns. Injecting a cortisone medicine into the area of hair loss may speed up the natural regrowth of hair. This treatment is known as an ‘intralesional steroid injection’. The regrowth occurs only in the area that has been injected. There is no way of preventing new areas of hair loss.

However if they appear, regrowth can be helped by further injections. Many other treatments have been introduced for alopecia areata, but the results are variable - no one has yet devised anything that works for everyone. Some lotions applied to the scalp do seem to result in temporary improvement in some people, but the hair falls out again as soon as they are stopped. Medicines which are often tried include topical steroids and minoxidil, and irritants such as dithranol. The most successful treatment to date has been immunotherapy. Immunotherapy works by provoking a contact allergic dermatitis in affected areas by applying a low concentration of a material to which the patient has been made allergic.

This is most often diphenylcyclopropenone (diphencyprone). Unfortunately the resultant dermatitis is irritating and may be unsightly, often accompanied by a swollen lymph gland. Therapists and others in contact with the diphencyprone can also develop dermatitis. For extensive hair loss, there is no reliable treatment. Steroid pills, or a special form of ultraviolet light treatment (PUVA), are sometimes worthwhile, but may result in side effects. An attractive wig is often the best solution. Some people need professional counselling to come to terms with the disorder, regain self-confidence and live full, productive lives.

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