AA is unpredictable, and repeated episodes are not unusual. Some cases last many years with some regrowth in one area, while at the same time new areas appearing. AA may also cycle through expression and remission. When hair does start to regrow, it tends to be of very fine "peach fuzz" hair, eventually regaining most or all of its normal color and texture. There is no actual loss of hair follicles (i.e. the "root") even in the hairless lesions. The follicles are not producing visible hairs because of the attacking white cells that surround the root. Hair follicles are capable of taking a lot of punishment. Despite the attack by immune cells the hair follicles usually remain capable of re-growing even after years of attack. However in severe cases this becomes less and less likely as years pass. Treatment depends on the extent of the disease, and the age of the patient. For small patchy disease, intralesional steroid injections (Kenalog(r)) are the best approach. This is injected with a tiny needle directly into the patches on the scalp with injections spread over affected areas. Injections are repeated every 4 to 6 weeks. The amount of steroid used is safe as long as reasonable limits are not exceeded. Other options include topical minoxidil (Rogaine) and prescription steroid lotions. These are better for moderately extensive cases.
For more severe widespread disease, options include short contact anthralin treatment (Micanol) and contact hypersensitization. The most effective treatment currently available is contact hypersensitization with some studies showing 40% success rates. It causes a local dermatitis (rash) with swollen lymph nodes. Treatment needs to be continued from months to a year or so to get a good result.
(published with permission in writing from:www.aocd.org)
