Alopecia Areata – time to think outside the square?

Alopecia areata (AA) is known to be an inherited condition which occurs in ‘atopic’ families.* AA is autoimmune in origin; one’s immune system becomes distracted, over-stimulated – and produces attacking antibodies against the host.Depending upon the type of autoimmune condition pre-disposed to, the immune system may attack any body system – but the two most common tissues are the thyroid gland (as autoimmune thyroiditis – ‘Graves or Hashimotos’) – and the skin.

Again – depending upon susceptibility – there are many autoimmune conditions which affect the skin or its appendages**. In AA the body’s white blood cells (activated CD+4 T lymphocytes) infiltrate in & around the hair follicles and begin attacking the colour pigment of the hair shaft. The common form of AA is readily recognised by its distinctive oval ‘spots of baldness’ and – under image enhancement – exclamation point hair ‘stumps’.

Twenty years ago when I decided on a career change from working as a Registered Nurse to training as a Trichologist I believed Dermatologists would – by virtue of their many years of training – know more about hair loss conditions & causes than I ever would ….. I am no longer surprised at how little they seem to know (in relation to scalp hair loss); how limited their treatment options, or their seeming inability to interpret the nuances of the different forms of scalp hair loss & what it might be indicating about the person who’s experiencing it (my opinion based on my experience only).

I’ve often discussed this puzzling ‘blind spot’ in Dermatology understanding with my close professional associates & teachers – all of who are medical or pharmaceutical researchers and active Practitioners. Their views are these:

  • “Medical thinking/University training is slow to change…”
  • “Conventional ‘top down’ best practice attitudes…” i.e.: this is the way it’s always been done so ‘who are you’ (sic) to question there’s another way?
  • “Orthodox medicine is a disease model NOT a health model…”
  • “Increasing ‘vested interest’ drug company involvement in medical education & ongoing training…” i.e.: Pharmaceutical Drug companies are profits-driven; they want (their) drugs prescribed to patients. They do NOT want Doctors advising patients about nutrient deficiency and supplementation to correct the patient’s health complaints.

Orthodox medicine’s “myths” about AA:

  • AA is caused or triggered by ‘stress’: whether or not medical practitioners & Dermatologists have come to believe this simplistic reason for AA is uncertain – but this is what’s overwhelming conveyed to the patient.
  • Little or nothing can be done to arrest AA once active, or
  • The only treatments considered is Cortisone – injected, topical or taken orally (as Prednisolone) – or other immune suppressors & immunomodulators.
  • AA has “NO correlation” with the patient’s nutrient status, metabolic resources hormonal balance or other existing health conditions (such as autoimmune thyroiditis, or acute illness which activates an immune response).

Whilst new & stronger drugs are frequently touted as the latest ‘breakthrough’ treatment, the mind-set of orthodox medicine remains frustratingly unaltered in its traditional beliefs about AA.

There is also certain arrogance in the misguided belief that pharmaceutical drugs are the answer to all health issues. Holistic and integrative medical thinking is: “to restore homeostasis (balance) you provide the body what it requires to optimally run itself – and it will do the rest” (Van Zanden: 2012).

‘Stress’ is also a very simplistic & over-used term to describe how one’s body is (adversely) affected by emotionally-negative or tragic circumstances which happen in our lives. Severe or prolonged emotional stress can adversely impact on our health, leading to physical & mental illness – but the physiological stress of significant nutrient deficiency or body system disturbance must also be considered. Dr. John Lee (Lee: 2014) states: “What could be more stressful on the body than its cells not having the resources they require to maintain optimal functioning…”

Put in its simplest terms: though a person needs to be genetically pre-disposed to exhibit Alopecia areata; AA – like ALL forms of hair loss – is the body’s means of revealing an internal disturbance or deficiency. This point is so fundamental to understanding any form of hair loss that rarely – if ever – will the sufferer’s condition be resolved until this simple fact is understood by the treating practitioner.

My experience as a Trichology Practitioner:

  • Loss of – or changes in – scalp and/or body hair is always a ’marker’ of change within the body. This may just be the emerging secondary sex characteristics of post-puberty, natural ageing (menopause/andropause), or indicators to nutritional, metabolic, hormonal or autoimmune disturbance. Hair loss can also be an early forewarning of ensuing disease process – and as such – should always be investigated.
  • Remembering simple rules:
    • ‘Things aren’t always as they appear’ – signs & symptoms in a visual assessment may be suggesting a ‘cause’ but this should always be established and confirmed in the ‘evidence’ of pathology results.
    • ‘The patient knows their own body best – it’s a self-evident statement that every individual is ‘different’ and they (with few exceptions) know what is ‘normal’ for them in terms of how they’re feeling in themselves. It’s up to the practitioner to interpret the hair loss & other ‘clues’ and establish the cause/s to the problem.
    • ‘If hair loss is excessive (for you as an individual) then it’s excessive’ – the common cliche that “losing 50-100 hairs per day is normal” is incorrect. Again the client is best judge of normal vs. excessive scalp hair shedding for them.
    • Test for the common causes first – the manner in which scalp hair loss occurs is also often an indication of the cause/s behind it. Additionally there are more common reasons for scalp hair thinning in females than males, and these should be first consideration after taking a detailed history.
    • ‘Within the reference range’ is not acceptable for hair due to it’s non-essential status in nutrient-metabolic-hormonal terms. Hair is a continually growing tissue and as such requires constant availability of essential nutrients – but is adequately supplied only after vital tissues, organs or body systems are provided for. ALL nutrient-metabolic-hormonal ranges should be minimum 50th percentile & ideally above 75th percentile for optimal scalp hair growth.
    • The Gut must always be considered – 70% of our immune defences lie along the Gut wall, and the immune system can be distracted & over-stimulated by Gut ‘dysbiosis’ i.e.: lack of essential micro-flora numbers (Lactobacilli, Bifidobacterium, Streptococci and E. Coli), unwanted parasites, fungi or bacteria; insufficient stomach acid or pancreatic enzymes to break-down foods ingested. Intestinal permeability (‘leaky gut’) is although thought to be implicated in the activation of some autoimmune conditions***.

It’s important to note procedures such as endoscopy or colonoscopy assess the alimentary canal’s**** tissue & structure integrity – NOT gut ‘function’. This must be assessed by faecal analysis – complete digestive stool analysis (CDSA), Faecal PCR and/or stool antigen for Helicobacter Pylorri etc.

In summary – if you are experiencing Alopecia or other forms of hair loss don’t look to prescription drugs as your first response – but listen to your body!

If you also feel excessively tired, experiencing fluctuations in your weight, mood, concentration, sleep patterns – these are often part of the same underlying signs as your hair loss or scalp condition to internal deficiency or disorder.

What your body is telling you should be assessed by an experienced Practitioner who understands the distinctions of these signs & symptoms, and can suggest the appropriate testing to uncover the ‘reasons why’.

Do not accept ‘stress’ or ‘nothing can be done’ or ‘it’s just part of ageing’ as a final or reasonable answer to your concerns – again – your body is telling you something’s not right within and asking you to fix it. As the saying goes: if you trash this body – where else are you going to live..??!!

Copyright Anthony Pearce 2014

*Families who have an increased sensitivity to their environment. Allergies, sinus/rhinitis, eczema, hay-fever are examples of ‘atopy’.

** Skin appendages are hair follicles, sweat glands & sebaceous (oil) glands.

*** Almost ALL AA Clients who consult me – and have their Gut function assessed – are found to have significant Gut dysbiosis from varying causes.

**** Stomach, bowel & rectum