Alopecia Areata 101

In this episode of the Skincredible Podcast, Dr. Lisa Swanson and Ana dive into the world of alopecia areata — an autoimmune condition that causes hair loss and affects both children and adults. From patchy scalp hair loss to loss of eyebrows, eyelashes, and even body hair, Dr. Swanson breaks down the many ways alopecia can present and why it’s so much more than a “cosmetic” condition.

Dr. Swanson explains the science behind alopecia areata, including how the immune system mistakenly attacks hair follicles, the connection to stress and other autoimmune diseases, and the differences between alopecia areata, alopecia totals, alopecia universalis, telogen effluvium, traction alopecia, and loose anagen syndrome. They also discuss why hair plays such an important role in identity, confidence, and emotional well-being — especially for kids.

You’ll hear practical guidance on what people should know, common misconceptions, when blood work is helpful, and why internet searches can sometimes create unnecessary fear. Most importantly, this episode offers hope: today’s treatment options for alopecia areata are more effective than ever before.

Whether you’re personally affected by hair loss, supporting a loved one, or simply curious about the science of hair and skin, this compassionate and informative conversation is packed with insight.

Plus — stay tuned for the next episode, where Dr. Swanson dives deep into the newest treatments changing the future of alopecia care.

Keywords

Dermatology, Hair Loss, Alopecia, Alopecia Areata, Alopecia Totalis, Alopecia Universalis, Diffuse Alopecia, Loose Anagen Alopecia, Traction Alopecia, Hair, Skin, Skin Expert, Dermatologist

Links, Attachments

National Alopecia Areata Foundation (NAAF): https://www.naaf.org

Chapters

00:00 Intro & Welcome

01:00 Alopecia Areata

02:48 Autoimmune conditions

05:16 How Alopecia Areata Presents

06:53 Diffuse Alopecia, Telogen Effluvium

12:50 Treatment Options Are More Abundant Now

13:40 Resolution vs. Treatment or Progression

15:50 Eyebrow Loss

16:55 Alopecia Areata Is NOT Cosmetic

18:25 Barbie & American Girl With Alopecia

20:15 Sudden Hair Loss, Ringworm (Tinea Capitis)

22:02 Joy From Treatment

24:25 Traction Alopecia

26:00 Disney Princess For A Day

27:13 Loose Anagen

30:15 Alopecia Recap

31:00 Thank You & Goodbye 

The information shared on this podcast is for educational purposes only and is not a substitute for personalized medical advice. Always consult your  physician regarding your health.

Transcript

SPEAKER_02 0:04

Welcome to Skin Credible, where we tell you what you should know about your skin and how to glow.

SPEAKER_00 0:13

Because your skin's incredible. Hello, everybody, and welcome to a super fantastic episode of the Skin Credible Podcast. I am your host, Dr. Lisa Swanson. I'm here with Anna. Yes. And we're gonna start our next chapter in terms of particular skin conditions. We've talked a lot about eczema related things. We talked about molluscum. We've had some wonderful episodes on climate change and GLP1s. But I wanted to circle back to a dermatologic issue and start our next chapter on a condition called alopecia areata. Tell us about it. Alopecia areata. Alopecia areata. And what I tell families is that alopecia is a nonspecific term that just describes hair loss. It could be from any number of conditions. Okay. Alopecia areata is a specific type of hair loss that most commonly presents as round, bald patches, most classically on the scalp. Okay. But it can affect the beard in men. Oh. Sometimes I'll see it. Well, back when I saw more adults, like I'd see it in beard the beards of men. Yeah. Um, most of the time that didn't bother them too much, but uh, you know, on your scalp it's more of an issue. And then can affect eyebrows and eyelashes. It can affect really any body hair, but those are probably the areas where people are most bothered by it. Would you lose all of your eyebrows or would it still just be a circle? Either way. So sometimes it's just like a sparseness in one area. Sometimes they will patients will lose all of their eyebrows. That can happen. Alopiciariata is an autoimmune condition. Okay. And the body simply makes a mistake and goes after the hair follicles. And when you biopsy alopiciariata, if you're unsure of the diagnosis, so you do a biopsy, you see what we call a swarm of bees of lymphocytes. These are white blood cells that are actually attacking the hair follicle.

SPEAKER_01 2:23

Oh wow. Yes.

SPEAKER_00 2:24

So you can see that under the microscope if you do a biopsy. Your body like attacking your own hair. It is. It is, yeah. And and we don't know why it does that. Being an autoimmune condition, if you or a family member have been diagnosed with an autoimmune condition, it does increase the chances that you will have an autoimmune condition. And sometimes that means it's the same one.

SPEAKER_01 2:49

Okay.

SPEAKER_00 2:50

But most times it means that your family member had thyroid disease, hypothyroidism or whatever. And that tendency towards autoimmunity put you at risk for something like alopecia areotic. Not necessarily even thyroid.

SPEAKER_01 3:04

I mean, it could be thyroid, but it could also be something else. Correct, yes. I was at dinner with a friend last night and I told her we were gonna do an episode about alopecia, and she was like, I had a lupus flare and I lost all my eyebrows. Oh, and I was like, Oh my gosh. Yeah. And I was like, just like that, and yeah, it never came back. Oh my gosh. So we could make it come back.

SPEAKER_00 3:23

We'll talk about that in the second episode. But we could make it come back. Often patients with alopecia areata will trace back a stressful event as the uh thing that preceded the onset. Okay. It's hard to know for sure. I mean a lupus flare, yes, that's serious stress. It's it's hard to know. We all have stressors in our life. And yeah, so it's hard to truly say, oh, that made this happen. Yeah. But a lot of patients will report, oh, I was really sick or whatever, or I went through a big, a big thing, emotional or physical or whatever. Sure. Um, and then shortly thereafter developed alopecia eriata. Okay. However, when I see particularly a child with alopecia eriata, I won't universally do blood tests for all kids with alopecia eriata. There was a study that showed that you'd have to screen 10,000 otherwise healthy kids with allopiciata to find one doctor. Yeah. Yeah. So, you know, I take a basic history, you know, how are they growing? How are they eating? How are they sleeping? Are they hot all the time, cold all the time? Are they constipated all the time, having diarrhea all the time? Yeah. If they're an otherwise healthy kid, I don't go to the blood test to check for a thyroid disease. And let's say you have a patient with allopiciata and you do the blood test, and lo and behold, they're hypothyroid. Would treating their hypothyroidism treat their allopicariata? Would it? No. Oh.

SPEAKER_01 4:58

No. It's just something else we discovered and now need to treat. Exactly.

SPEAKER_00 5:02

So like having one of these conditions means you're more likely to have another, but one of these conditions is not driving the other. Okay. Does that make sense?

SPEAKER_01 5:10

And one won't treat treating one won't treat the other. Exactly.

SPEAKER_00 5:12

Yeah. Okay. Yeah. Um now alopiciariata can present in a multitude of ways. So the most common is like round patches on the scalp. Um, it can also present as loss of eyelashes, loss of eyebrows, sometimes even loss of nose hairs. Oh, that'd be nice for. So it's interesting you say that, Anna, because it seems nice. Because when you have nose hairs, you don't necessarily understand. Do they protect you from disease? They do. And like they, if you don't have nose hairs, everything you breathe goes just right up.

SPEAKER_01 5:51

I take that back. Whoever was listening, I take it back. Yeah.

SPEAKER_00 5:55

Yeah, I want my nose hairs. Yes. So like allergens, pollutants, smells.

SPEAKER_01 6:00

No, no.

SPEAKER_00 6:01

Like there's nothing in its way. Oh gosh, no. Yeah. Yeah. Yeah. In fact, I've had some patients, so you can have most commonly what we call patchy alopecia areata, where you have a few patches here and there. And then you can have alopecia totalis, means loss of all the hair on your head. And then you can have alopecia universalis, which means loss of all hair on your body.

SPEAKER_01 6:23

Everywhere.

SPEAKER_00 6:24

And in s in one of my patients with alopecia universalis, we got him on a medicine to treat it. And he said the area that he was most excited about was getting his nose hair spent. Which is so funny. It's so funny. But like again, you don't realize the role they play. Because it's so annoying. Like everything he breathed through his nose and every little thing went all the way back up into the back of his throat. Yeah, not good. It's hard. Yeah. Um, and then there is even a special type of allopiciata called diffuse allopiciata, which presents similarly to something called telogen effluvium. And telogen effluvium is super, super common, and so I think it's worth spending just a couple moments on that.

SPEAKER_01 7:05

Yeah, I have that.

SPEAKER_00 7:06

Tell me about it. Yes, yes, yes. So our hair goes through three cycles. Yeah. Every hair on our body is somewhere in these cycles. It starts in the antigen phase, which is the growing phase. Your antigen phase has a predetermined duration of time.

SPEAKER_02 7:25

Okay.

SPEAKER_00 7:25

If you've ever wondered why your eyebrows don't grow as long as your hair, it's because it has a shorter antigen phase. Okay. It's not programmed to get as long as the hair on our head.

SPEAKER_01 7:37

Thank goodness.

SPEAKER_00 7:38

Yes, right? Yeah, that'd be something. If you had to have your eyebrows like trimmed or whatever. And so we have the antigen phase, which is the growing phase. Okay. And then we have cadogen, which is where it rests for a period of time, usually just like two or three weeks. And then telogen, which is where it's in its shedding phase. Every hair on our body is somewhere in this antigen, cadogen, telogen.

SPEAKER_01 7:59

And not all hairs are at the same time.

SPEAKER_00 8:01

Oh gosh, no. That would be that they would go periodically bald every two to three years. Okay, that'd be terrible. Okay. So they're cycling, right? And it's normal to lose about a hundred hairs a day from your scalp, just from this normal cycle.

unknown 8:14

Okay.

SPEAKER_00 8:15

In times of stress, and that can be medical stress. You were really sick. We saw a lot of it from COVID. Had surgery. It can be emotional stress. You go through a death in the family or a divorce or some other sort of trauma. Sure. It can be physical stress, like you injured yourself and you're hurt. It can even be good stress, like after you have a baby. A lot of women go through this telogen of fluvium process. Your body decides, hey, we've got more important things to be working on right now. We're gonna back burner everything that isn't essential. Oh. Because your body is trying to keep the ship afloat. And it's like we don't need to worry about, you know, the making the beds on the cruise ship. We need to keep the ship afloat. Okay. And so it shunts a percentage of your hair is from antigen to telogen. It's a programmed hair shedding. And people will notice increased shedding, like in the shower when they're shampooing, sometimes even on their pillowcase in the morning, there will be a like a tuft of hair. Telogen effluvium is a reversible thing. Typically, whatever triggered it is something you recover from.

SPEAKER_01 9:33

Yeah.

SPEAKER_00 9:33

And the cycling begins again and everything is fine. The shedding can last about three to six months, and then the rebuilding occurs, and everything is fine. It doesn't produce any long-term damage.

SPEAKER_01 9:46

So no one really ever gets stuck in the telogen of lubium forever.

SPEAKER_00 9:49

Some people can if your inciting incident is a chronic one. Oh, gotcha. So like lupus, even. Like lupus, chronic condition, hopefully well controlled, because we've got some great medicines these days. But if you have a chronic condition that's continuing to put that stress on your body, your body is gonna continue to go into protective mode. Protective mode. Yes, yes. And and do everything it can to keep your ship afloat. Sure. Um telogen ifluvium, if there isn't an obvious cause, like when I'm seeing patients for this, I ask about like preceding surgeries, illnesses, um, emotional stressors, big moves. Even for young kids, sometimes even just like their family moves, and it's like a big move. Um so I ask about all of those things. If the answer is no to all of those things, then I do a little bit of blood work to see, you know, to kind of check under the hood and see if there's any other underlying issue that's triggering the telogen of fluvium. So we check what's called a CBC, which checks for anemia. We check what's called serum ferritin, which is an iron level, we check thyroid with a TSH, and we check a vitamin D. Uh, and so we make sure everything's okay. If we don't find anything, like there's no stressors that could have triggered it, the labs are all normal, then we consider a diagnosis of diffuse alopecia areata. Because diffuse alopecia areiata presents in a similar fashion to teleginifluvium, but there's no cause. Yeah. You can't find a cause. And then you're like, okay, we're dealing with diffuse alopecia areata.

SPEAKER_01 11:33

So stress always are we are you always able to um to pinpoint the stressor, you know, or like are there people who aren't stressed who come in and then you're like maybe more suspicious of the diffuse alopecia?

SPEAKER_00 11:45

It's typically a big str it's a memorable stressor. Yeah. And and it typically happens three to six months before the shedding begins. So if I saw a patient now in May, I would be like, what was happening between like Thanksgiving and Christmas? Yeah. You know? Okay. That actually makes a lot of sense. I kind of pick a time where like our memory is like, okay, yeah, let me think back to Christmas time. What was I doing and what was I going through? Yeah. Um, it's not like, oh, maybe I had a cold. Like, you know, like that would it's like once your attention is directed on this time frame, yes, oh yeah.

SPEAKER_01 12:19

Yeah.

SPEAKER_00 12:20

I vividly remember that that during this time this happened to me. Um, and if you're not hearing that and the blood work is all normal, then typically I presume it to be diffuse alopecia areata.

SPEAKER_01 12:33

How hard is that to treat?

SPEAKER_00 12:34

Um, alopecia areata, we're gonna dive in deep in the next episode where we talk about all the treatment options available. It's gotten so much better. Okay, so much better to treat alopecia areata. Alopecia areata used to be the kind of thing that you saw in clinic, and especially if it was significant, like Totalis Universalis, your heart just sunk because you're like, I just you know, everybody in medicine is in medicine because they want to be able to help people and fix people. And those were so frustrating because you just like you couldn't. You felt like helpless helpless and patients felt helpless and doctors felt helpless. And um, but now completely different story, completely different story. We have so many things that's encouraging and more on the way, and so lots of ways to help, lots of ways to help. Um, but more on that in the next episode. So, like, definitely tune in. Stay tuned. Um, and we'll dive in deep. One thing I tell families when they come in, especially with a kiddo with alopecia areata, is I say alopecia areata can take three potential courses. Okay. One course is that it happens, the um alopecia improves, the hair regrows either because of our treatment or just because spontaneous regrowth does happen and is more common in kids than in adults. So, like sometimes the hair just comes back. Okay. And then it never happens again. And it was like a one-time fluky situation, like who knows why. Sure. Second potential path is that it happens, the hair regrows, either because of what we do or just because, and then down the road it happens again. So every few months or few years, you get like two, three, four patches, and you just kind of cycle that way. The third path is that it progresses to alopecia totalis or universalis, which is loss of all the hair on the head or all the hair on the body. That is less than 2% of all patients with alopecia areiata. But when you Google alopecia areata, those are the pictures you're going to see. Oh no. Right? So I always make sure to mention this to families because I know they'll go home and Google, yeah, and I don't want them, their screen to fill up with all these pictures of hairless kids. Yeah. And they're like, oh my gosh, what's gonna happen? Yeah. And they just spiral. So that's less than 2% of all kids with alpiciariata, less than 2% of all kids and adults with alpiciariata. When it develops into Totalis Universalis, it happens quickly. Oh wow. It happens quickly. So often by the time I see a patient, usually it'll take them like from like the parent noticing the spot to like calling their pediatrician to then getting the referral to see me. Usually that's like two to three months sort of situation. By the time I see the child, the hair is gone. Oh man. So when I see a kid with patches, I'm confident we're gonna we're gonna stay in patches. Yeah. Not to minimize, but like we prefer that to the complete loss. Yeah. Um, and so that's how I break it down with families to tell them about like what the future potentially holds and also relieve any fears that might stem from the internet later on that day when they go down and Google. Yeah, yeah. Um, different areas of the body can be affected, and those areas have burden. We I mentioned the nose hairs, eyebrows. Not only are they part of our aesthetic, they also guard against sweat dripping into your eyes.

SPEAKER_01 15:56

I never thought about that. Yes.

SPEAKER_00 15:58

So again, these things that like the function it serves, yeah, you don't necessarily notice until the hair is gone.

unknown 16:07

Wow.

SPEAKER_00 16:08

Yeah. And so even these areas that some people might say aren't as aren't as crucial, like still there's a function there. Yeah. Now, when alopiciariata affects like the armpit or the legs, you're like, great.

unknown 16:21

Yeah.

SPEAKER_00 16:22

You're like, I don't have to shave anymore. Like that's that's wonderful. Let's keep that going on, you know. Um, but these other areas of involvement can have a big burden associated with it. Yeah, yeah. Um alopiciariata is something that can self-correct, like spontaneous regrowth is possible, but the more severe it is, the less likely you are to get spontaneous regrowth. Gotcha. And the more severe it is, the more we want to intervene, of course. There is a misconception amongst insurance companies, but also amongst some medical clinicians that alopiciariata is cosmetic. Oh it's not. Yeah. It's not. This is an autoimmune condition. This is important to treat. Anytime I have an insurance company, this is this might be this might be bad karma, bad juju to put out there. But anytime there's an insurance company that denies a treatment for an alapiciariata patient and refers to it as cosmetic, there's a small part of me that hopes one day one of their family members has the condition. You know? Like, you don't understand. You don't understand. Our hair is our it's part of our identity. It's how we view ourselves in the mirror every day. And it's it's a very important thing, especially in the little girls. Like, I wish and hope that one day we have a short-haired Disney princess. Yeah. We need a short because they all have this beautiful long floor. Yeah. And then the little girls come in and they're like, I want to be like Elsa and Anna. And the girl from Tangled, I forget her name. Um, and that's really hard. That's really hard. And so we are we try to give the patients what they need to succeed and to feel like themselves, but we need a short-haired Disney princess. We do have a Barbie with alapisariata. Oh, yes. And an American girl doll with alopiciariata.

SPEAKER_01 18:31

Oh, do they have like what kind of topic? Oh wow.

SPEAKER_00 18:35

Yes. Um, and I think that's a great thing. That's so great. Yeah, it's a great thing.

SPEAKER_01 18:40

Very inclusive.

SPEAKER_00 18:41

Yes, yes. And there's a wonderful foundation for folks with allopiciata, National Alapiciariata Foundation, NAF. It's a wonderful resource for patients and families who are dealing with alopecia areiata, and they um have like activities for kids, they have educational things for parents, they have support groups and all that kind of stuff. In fact, there was a parent of one of the kids that I saw back in Colorado who organized the Colorado division of NAFT. That's really cool. And they would do fun events, go to the zoo, go to the movies. It's really cool when kids with skin disease get to meet other kids with skin disease.

SPEAKER_01 19:22

They feel less alone.

SPEAKER_00 19:24

Because like alpha is actually pretty common. Like it's it's out there. A lot of times you don't see it because people are wearing hats or wearing uh cranial prostheses, otherwise known as wigs, or they're doing some sort of camouflage and things like that. Yeah. So sometimes it's not as obvious, but it is very much out there and very common. And it helps for kids to kind of see that so that they know they aren't alone. There are lots of other kids their age that are dealing with this. Alopiciariata can present at any age. So we see it in littles, and you can have nuance at alopeciariata as a as a grown adult. Yeah. It doesn't have a preference. It can be, it can be kind of anybody.

SPEAKER_01 20:06

And you won't, it's not like there's like a warning sign. Sometimes you don't notice until there's like just a little patch of skin in there.

SPEAKER_00 20:12

Correct, correct. In fact, a lot of times in the kiddos I see, the parents, the first thing they notice is a bald patch, like a round bald patch. They don't know, nobody seems to know where the hair went. Yeah.

SPEAKER_01 20:24

Um It's not like they just got a clump all of a sudden when they notice the patch.

SPEAKER_00 20:28

Yeah, yeah. And a lot of parents will first assume, like, oh my gosh, did somebody pull your hair? Like, did your sister or your brother pull your hair? Yeah. Did um somebody at school pull your hair? Like that's the first thing their brain goes to. Sometimes also it can be misdiagnosed as um as uh ringworm. Yeah. Tinea capitus. Okay. Because fungus on the scalp, otherwise known as ringworm, otherwise known as tinea capitus, can cause alopecia. The hair can go away. But there are other clinical signs. There's always scaliness, whereas alopecia areata is smooth. Yeah. But in tinea capitus, always scaliness, often redness. Alopecia areata typically doesn't have any redness. Sometimes the skin affected will even have like kind of a yellow-orange color to it. Okay. Just like a little bit. I guess those are the major differences. Scale, redness, and most kids pick up tinea capitus from other kids or from pets and stuff like that. But sometimes I'll see kiddos with alpiciariata and they were diagnosed by the pediatrician as tinea capitus. Gotcha. And it's like, well, there's no scale here. So it's not that. Yeah. Um, it's a very scary thing for families to go through. Completely understand and empathize. Um, completely scary thing. And the the parents are worried about like what the future holds for the kiddos. And when adults are affected, they're like, oh my gosh, like what does the future hold for me? Like, how bad is this gonna get? And it can be very emotional. There are a lot of tears during visits for alopecia ariada. Understandably, understandably. The cool Thing is, there's now a lot of happy tears too.

SPEAKER_01 22:04

I love that.

SPEAKER_00 22:05

Once treatment happens and the hair regrows. Honestly, it's one of my favorite things to treat alopecia arriata now because the joy I get out of seeing the hair regrow, the child get back to themselves. Yeah. I take pictures of my patients to follow their alopecia arriata journey at baseline and then as we go along uh during treatment. And not only do you see the hair regrow, but you see like the light come back to their eyes. And it's just very fascinating when I go back and look at the pictures.

SPEAKER_01 22:43

Yeah, that's cool.

SPEAKER_00 22:44

And it's just like, oh, that's a really cool thing. It's a really cool thing. Boys are a lot luckier than girls with alopecia erata because you know, if you have a male patient with alopecia erata, they have a couple patches, you get them started on treatment, the hair regrows. Within two, three months, everything looks pretty normal. But when a girl, say she has, you know, like hair down to like elbow length or whatever, and then she gets a few patches, and then those regrow. But of course they're starting from tiny, teeny, little eyebrows back there. Right? Yeah. And then, and so those start to get a little bit long, and then maybe she gets like a couple new patches, and then those that can be really rough because they come in and they have these hairs of different lengths and everything, and it can be hard to get kind of a uniform look to the allopiciariata. Um, but we can we can do it these days, and that's one of the most exciting things.

SPEAKER_02 23:39

Yeah.

SPEAKER_00 23:40

I remember when we had a big breakthrough in the treatment of allopiciata with our oral jack inhibitors, which we'll dive in deep to. But the title of the article was New Hope for the Hopeless. Oh, I know. And I think that really encapsulates what these breakthroughs were.

SPEAKER_02 23:58

Yeah.

SPEAKER_00 23:58

There were patients with alopecia totalis and universalis, and we didn't even try to treat. Like it was considered beyond the point of treatment. And though those conversations were so hard and mostly about like, can I help you get a uh cranial prosthesis? Can I help you with that? And now we don't have to settle for that.

SPEAKER_01 24:19

That's amazing. It's really cool. Yeah, it's really cool. I had friends growing up who were African American who would get like bald spots from their braiding. Like, is that also treatable?

SPEAKER_00 24:31

Yes, and it's it's very important to address it early on. So that's what we call traction alopecia, and it's where the hair is is pulled tight, doing like a style with braids, or like if you wear a hijab and things like that. So the hair is pulled tight and it puts traction on the root, and so it causes hair loss in the area. If that continues, yeah, it produces scarring. Oh, wow. And then it's a permanent alopecia situation.

SPEAKER_01 25:02

Oh man.

SPEAKER_00 25:03

So when you do see signs of traction alopecia, important to find solutions fast, meaning just a different kind of hair do that puts less traction on the hairs. Okay. And there's a lot of ways to do that, even in patients who are African American and do the braids, the hair specialists that they see, there are techniques and things that will put less tension. Okay. So that I'm glad you mentioned that because that's something that, if left to its own devices, um, can become a permanent alopecia, but if identified early, we can fix it. Okay. Um one of the first signs of traction alopecia can be little red, almost like pimple-like bumps at the areas of the traction. So if if you're noticing that on yourself or your child or whatever, um, that can be the first sign that there's there's too much traction. There were even, there was even an article published about Disney and their be a princess for a day thing. So when you go to Disneyland or Disney World, you could sign up your little girl for this be a princess thing. And you would go and they would do your makeup and your hair, and they would do a really tight updo. Oh. And we were seeing little girls with you know, traction alopecia from just their day at Disney. Oh no. Because it was pulled so tight.

SPEAKER_01 26:32

That's an unintended consequence.

SPEAKER_00 26:34

Yes, yes, you don't feel as princessy when that happens. Yes. Um, and so you know, I I think recommendations were made to Disney, like you can still do the updo, but just not so tight.

SPEAKER_01 26:46

Not so tight. I think good to pay attention to for like gymnasts, friends who like because kids are gymnasts, they pull their tight hairs like sometimes their faces look all like taut. Yes, yeah, yes. Good to know.

SPEAKER_00 26:56

And like anything where your hair is pulled so tight it's giving you a headache. Yeah, you know, like that's a warning sign too. Okay. Um, so very important to kind of address and treat. Yeah. One other type of alopecia that's probably worth a little bit of a mention. There's something called loose antigen. And it's technically called loose antigen syndrome, but I don't like the syndrome because there's no other associated things with it. Yeah. So I think syndrome is not an appropriate use of the term. Sure. Um, but this occurs in young girls. Okay. Always girls. Now, boys probably have it too, but their hair is shorter, so we don't see the clinical features. Okay. But these will be the classic loose antigen uh patient, is a little girl, three to five years old, typically blonde. We don't understand why, but typically blonde. And their hair will not grow longer than their shoulders. They've typically never had a haircut in their life. They're three to five years old and they haven't had a haircut.

SPEAKER_01 27:58

That was like my sister. Was it? Yeah. I mean, she wasn't blonde, she was light skinned, but she my mom was like, we couldn't literally we didn't cut her hair. Like she just she just had looked like a little boy. Like she Yeah.

SPEAKER_00 28:09

That's crazy. And so what's happening is when our hairs are in antigen phase, the growing phase, they are anchored to the scalp. Okay. Okay. That's why it hurts when you pull them.

SPEAKER_01 28:23

Yeah.

SPEAKER_00 28:23

And that anchor is holding it on so it doesn't fall out until it enters enters telogen. Oh. In loose antigen, the anchor is broken. Oh. So once the hair gets to a certain length, the forces of gravity are too great and it sheds. Or if there's trauma to the head, and trauma can even just be like sleeping and like tossing and turning. Sure. The anchor is broken and so the hair comes out. Oh. This is the best type of alopecia issue to have as a young person. Okay. Because the girls outgrow it, typically around puberty. Did your sister outgrow it?

SPEAKER_01 29:04

Yeah, she does no longer she's able to grow her hair now.

SPEAKER_00 29:07

Yeah, yeah. Uh and so you don't you don't have to do anything, you don't have to treat it. Again, to the point that like we need a short-haired Disney princess to help us with loose antigen. Yeah. Um, because you know, their hair is is beautiful and normal, but short, and that's okay. Um, and they'll eventually one day outgrow it. Now, some people are using a little bit of rogain or a little bit of um low dose oral monoxidyl for loose antigen with reasonable results. Monoxidyl works, and we'll talk more about it in the therapeutics episode, but it works to prolong the antigen phase. Um, and so that those things can be helpful if people want to treat, but it is also nice, like this will get better. She's just gonna be a short hair girl, you know, for the time being, but it will get better. Yeah. And so a lot of people come in with that concern, and so and boys probably get it too, but it's just they're not trying to grow their hair as long. And so, you know, it it probably occurs in boys. We're just not seeing it. Yeah, yeah, yeah. So interesting. Yeah, alopecia areata, not cosmetic, huge life impact on both the patient and their family. Yeah, there's a lot of parental concern.

SPEAKER_02 30:19

Yeah.

SPEAKER_00 30:20

Um, presents in somewhat different ways, patchy, totalis, universalis, diffuse, can occur anywhere really on the body scalp, eyebrows, eyelashes, beards. Um and it's an autoimmune condition. The body has made a mistake and is attacking the hairs.

SPEAKER_02 30:38

Yeah.

SPEAKER_00 30:38

Three possible courses of the condition, one-time fluky deal, periodic recurrences, progression. It's important to see your dermatology specialist about this because there are ways that we can help.

SPEAKER_02 30:55

Yeah.

SPEAKER_00 30:55

And we're gonna dive into those ways in our next episode. Exciting stuff. Yes. Um, so thank you so much for tuning in, and we'll see you next time when we talk about LP chariot treatments. That's right.

SPEAKER_01 31:11

Follow us and share with your friends and tell them what we're all about so that we can help the most people possible. Love it. Bye. Thanks, guys.