Whelehans pharmacy alopecia areata part 2

Alopecia Areata (Part 2)
Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie
Last week I discussed treatment options for alopecia areata with less than 50% hair loss. For those with greater than 50% hair loss, treatment is different. Oral corticosteroids (eg. Deltacortil®) are sometimes prescribed for extensive scalp hair loss or when the condition is rapidly spreading. Corticosteroids taken orally are thought to be more effective than local injections of corticosteroids into the scalp. However, corticosteroids have many side effects, especially if used long term. Side effects of corticosteroids include stomach irritation, weight gain, osteoporosis, glaucoma, thinning skin and irregular periods in women.
PUVA treatment involves taking a psoralen which is a light sensitive drug and then undergoing a short exposure to UVA which is a long-wave ultraviolet light. Treatment takes place over a three to six week period with sessions two to three times a week.
Applying irritants or allergens to the scalp to cause an allergic reaction is sometimes used as a treatment for hair loss. The idea is that this allergic reaction then draws the T-lymphocytes away from the hair follicle, thus allowing the hair a chance to start re growing.
Immuno-suppressive drugs such as ciclosporin (Neoral®) or azathioprine (Imuran®) where developed to stop the immune system from rejecting transplanted organs following transplant surgery. Because alopecia areata is an autoimmune disease, immuno-suppressants are sometimes used. It is thought that by suppressing the immune system they stop T-lymphocytes attacking the hair follicles. However the main problem with suppressing with the immune system is that it can lead to a lowered resistance to infection. Apart from Rogaine®, all of the above medicines listed are only available through a specialist in hair loss (a trichologist). It is best to be referred through your GP.  
Cancer treatment hair loss
This is different from Alopecia Areata. This is hair loss caused by chemotherapy or radiation used for the treatment of cancer. Its scientific name is anagen effluvium and the hair loss is usually sudden, and occurs between 1 to 3 weeks after the start of cancer treatment. Often the hair falls out in large clumps and in many cases it occurs overnight. Up to 90% of hair is sometimes affected. However this type of hair loss is temporary and hair grows back once treatment is finished; however the hair may not grow back as thickly as it was prior to treatment. On the other hand, some people find it grows back thicker and healthier than before treatment. Some people find that when it grows back, it is a different texture, for example curly hair growing back straight or the hair changes colour.  Not all chemotherapy drugs cause hair loss so the doctor will advise in advance if it will occur. Some patients decide to wear wigs while their hair is lost and nowadays there is a great selection of very natural looking wigs. The cancer team in hospital or pharmacist can advise on where wigs are available.

Where to get wigs locally
I sometimes get asked where wigs are available locally for the likes of people with severe alopecia or undergoing chemotherapy. Joli Hairdressers (04493 95921) offer a good range of quality wigs, headwear and scarfs. They have staff trained in this area and a private fitting area. Joli are a HSE registered wig supplier meaning that the HSE will give you an allowance towards your wig if you have a medical card. Some health insurance plans cover part of the cost.

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans