Circular hair loss
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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Circular hair loss is the most common inflammatory hair loss disease. It often runs in batches. The round, bald spots do not itch and do not show any skin changes such as flaking or inflammation. Why they occur is unclear. Read more about circular hair loss here: cause, treatment and prognosis!
Circular hair loss: cause
The cause of circular hair loss (alopecia areata) is not yet fully understood. The condition is not gender specific, which means that circular hair loss can affect women and men alike. In many cases, circular hair loss appears for the first time in children, but in other cases only in adults. So there is no clear connection with age either. However, various other factors are known that play a role in the development of the disease:
This primarily includes a disorder of the immune system.Experts suspect an autoimmune reaction in those affected: due to a dysregulation of the immune system, defense cells turn against cells in the hair roots. The result is a local inflammatory reaction that disrupts hair growth and ultimately leads to hair loss. This results in round, bald patches in the coat, mostly on the head. However, circular hair loss can affect the beard, eyebrows and other body hair as well. In the most severe form, those affected completely lose all body hair (alopecia areata universalis).
An autoimmune reaction in alopecia areata is also indicated by the fact that some affected people also have other autoimmune diseases, for example neurodermatitis or vitiligo (white spot disease).
A genetic predisposition also seems to play a role in circular hair loss: Sometimes it occurs in families. In some cases, psychogenic (partial) causes can be identified: In some cases, circular hair loss develops during stress, exams, after accidents or bereavement. What is certain is that circular hair loss is not the result of malnutrition (such as a lack of vitamins) or harmful environmental influences (environmental toxins).
Circular hair loss: treatment
"Circular hair loss - what really helps?" This is the question that worries those affected the most. Since the exact cause of alopecia areata is not known, there is also no causal therapy. There are just different treatment options that are aimed at stimulating new hair growth. Sometimes they help, but often they are also unsuccessful.
In the following you will find a list of different therapies that are effective either locally (on site) or systemically (in the whole body) and are intended to stimulate hair growth:
Skin-irritating substances against circular hair loss
The oldest form of treatment for alopecia areata is the application of skin-irritating substances to the bald areas. The resulting skin irritation is said to allow new hair to grow.
For example, about 0.5 or 1 percent anthralin (cignolin) can be applied to the bald areas and removed again after a short exposure time with a cloth (this prevents discoloration of the skin). In some patients, this treatment actually makes the hair grow back over time. However, if after three months there is still no success, the anthralin treatment should be discontinued.
Other skin irritants that are sometimes used for circular hair loss are chrysarobin, capsaicin (hot substance made from chilli) and tincture of pepper. However, they were only able to trigger hair growth in individual cases.
Minoxidil against circular hair loss
Solutions with the active ingredient Minoxidil are actually approved for the external treatment of hereditary hair loss. Sometimes, however, they are also used on a trial basis for circular hair loss, although no resounding success is to be expected here.
If circular hair loss is to be treated in children, a low-dose minoxidil solution can be used in combination with a medium-strength cortisone preparation (externally).
Glucocorticoids ("cortisone") against circular hair loss
Circular hair loss is now often treated with glucocorticoids ("cortisone") in the form of creams or solutions. Long-term successes vary and relapses are common. In a maximum of half of all cases, this local treatment method can make the hair grow again.
Sometimes cortisone is also injected into the bald patches of skin. Such cortisone syringes are only suitable for small herds of circular hair loss and not for the temples and crown area. The doctor should use caution when injecting and observe the total dose of glucocorticoid injected. Otherwise the active ingredient can get into the bloodstream in relevant quantities and trigger undesirable effects throughout the body (systemic side effects). These include, for example, a weakening of the immune system (with increased susceptibility to infection), water retention in the tissue (edema), menstrual disorders and Cushing's syndrome.
However, the likelihood of such side effects is higher if cortisone is used internally in the form of tablets. Such a systemic cortisone therapy is therefore only possible in severe, extensive cases of circular hair loss. It does indeed allow the hair to grow back in most patients. For this, however, cortisone must be taken for a long time in a dose that can trigger the above-mentioned side effects. If the cortisone dose is then reduced or the drug is stopped completely, the hair loss will start again.
Topical immunotherapy for circular hair loss
The effectiveness of local immunotherapy with the active ingredient diphencyprone (diphenylcyclopropenone, DPCP) for circular hair loss is scientifically proven. However, this method is only used for larger, bare herds:
First, the active ingredient is applied in a highly concentrated manner to the bald areas. It is supposed to trigger inflammation there and sensitize the patient's immune system to the active ingredient. After three to four weeks, a low dose of DPCD is reapplied, which then causes allergic skin irritation. The application is repeated weekly, usually for months.
Experts assume that this allergic skin inflammation on the bald areas of the scalp attracts certain immune cells that “displace” those immune cells that attack the hair root cells. In favorable cases, new hair growth begins after about three months, with initially pigmentless (white) hair sprouting. A few weeks later, pigments are usually stored in this hair, but sometimes the new hair also remains white.
Topical immunotherapy can actually make the hair grow back in around 80 percent of patients with circular hair loss. In almost every second patient, however, there is a relapse (shortly after the end of therapy). In the long term, this treatment is only successful in around 40 percent of patients.
Topical immunotherapy is quite complex and involves risks (such as excessive eczema). It should therefore only be carried out by specially trained doctors.
PUVA against circular hair loss
The abbreviation PUVA stands for psoralen plus UV-A. This photochemical treatment method is used for various skin diseases such as psoriasis and neurodermatitis. It can also be used for circular hair loss:
A phototoxic psoralen (such as methoxalen) is applied to the affected areas of the skin. After a quarter of an hour, the area is irradiated with UV-A light. This can inhibit damage to the hair follicles by immune cells.
Local PUVA is just as effective in treating circular hair loss as topical immunotherapy. However, the risk of relapse is even higher here.
Sometimes PUVA is also used systemically: The psoralen is taken internally before the hairless areas are irradiated with UV-A light an hour later. On the one hand, this type of therapy is not more successful than local PUVA. On the other hand, it carries a higher risk of skin cancer.
Zinc against circular hair loss
Zinc preparations are often recommended for circular hair loss (or other hair loss). The trace element ensures, among other things, a strong immune system and healthy skin and hair. However, taking zinc rarely helps with circular hair loss. But at least it has no side effects.
Support groups for circular hair loss
A surprisingly successful “therapy method” is participation in a self-help group: Patients with circular hair loss benefit from the joint work-up of the disease with other people affected. Especially with children, participation in a self-help group can be more effective than any drug treatment.
Alternative healing methods for circular hair loss
Sometimes patients with circular hair loss use homeopathy, Schuessler salts and other alternative healing methods. Their effectiveness has not been scientifically proven, but in general there is no harm in trying.
For example, homeopaths recommend taking alopecia areata Arsenicum album, Lycopodium clavatum, Phosphorus or Vinca minor. No. 5 is considered to be a suitable Schüßler salt Potassium phosphoricum. But also other means like No. 11 Silicea or No. 21 Zincum chloratum should help with circular hair loss.
Circular hair loss: prognosis
The course of circular hair loss cannot be foreseen. In general, the prognosis in children is better than in adults.
In many cases, circular hair loss heals on its own unexpectedly. The hair that grows back is initially very fine and colorless, later it usually shows its usual strength and color again. Sometimes this spontaneous healing is permanent, in other cases it is only temporary - the hair falls out again.
The chances of success of the various therapy methods are very variable. In general, a treatment is more likely to be successful if the circular hair loss has not been around for a very long time. The prognosis is poor for bald spots three years or older.
If the hair grows back under treatment, it is usually pigmentless (white). Those affected can then have patches of white hair on their heads, which doctors call poliosis. In some cases, it will relapse later and the hair will fall out again.
Some sufferers ultimately decide to wear a wig - especially if the circular hair loss affects the entire head.
Tags: therapies anatomy palliative medicine
