Circular hair loss: cause, therapy, prognosis

Martina Feichter studied biology with an elective in pharmacy in Innsbruck and also delved into the world of medicinal plants. From there it wasn’t far to other medical topics that still captivate them. She trained as a journalist at the Axel Springer Academy in Hamburg and has worked for NetDoktor since 2007 – first as an editor and since 2012 as a freelance writer.

Circular hair loss is the most common inflammatory hair loss disease. It often runs in batches. The round, bald areas do not itch and show no skin changes such as scaling 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) has not yet been elucidated. The condition is not gender-specific, which means that circular hair loss is equally common among women and men to meet can. In many cases, circular hair loss occurs in children for the first time, but in other cases only in adults. So there is no clear connection with age either. Indeed knows various other factors that play a role in the development of the disease:

This primarily includes a disturbance in the immune system. Experts suspect one of those affected Autoimmune reaction: Due to an incorrect regulation of the immune system, defense cells are directed against cells in the hair roots. The result is a local inflammatory reaction that disrupts hair growth and ultimately leads to hair loss. This creates round, bald spots in their coat, mostly on their heads. However, circular hair loss can also affect beard, eyebrows and other body hair. In the most severe form, those affected lose all body hair (alopecia areata universalis).

An autoimmune reaction in alopecia areata is also supported by the fact that some people have other autoimmune diseases, such as 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 make out: In some cases, circular hair loss develops with stress, Exams, after accidents or bereavement. It is certain that circular hair loss is not the result of malnutrition (such as vitamin deficiency) or harmful environmental influences (environmental toxins).

Circular hair loss: treatment

"Circular hair loss – what really helps?" This is the question that most concerns those concerned. Since the exact cause of alopecia areata is not known, there is no causal therapy. There are only various treatment options that aim to stimulate new hair growth. Sometimes they help, but often they are also unsuccessful.

Below you will find a list of different therapies that are effective either locally (on site) or systemically (throughout the body) and are intended to stimulate hair growth:

Skin irritants against circular hair loss

The oldest form of treatment for alopecia areata is the application of skin-irritating substances to the bald areas. The triggered skin irritation is said to grow new hair.

About 0.5 or 1 percent anthralin (cignolin) can be applied to the bald areas and removed after a short exposure time with a cloth (this prevents discoloration of the skin). In some patients, this treatment actually makes the hair grow again after some time. If, however, after three months there is still no success, the anthralin treatment should be stopped.

Other skin irritants that are sometimes used for circular hair loss are chrysarobin, capsaicin (spicy chilli) and pepper tincture. However, they could only 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 can 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 often with glucocorticoids ("cortisone") in the form of Creams or solutions treated. Long-term success varies and relapses often occur. In a maximum of half of all cases, this local treatment method can let the hair grow again.

Sometimes cortisone is also injected into the bare skin. Such Cortisone injections are only suitable for small herds of circular hair loss and not for the temple and parting area. The doctor must be careful when injecting and take into account the total dose of glucocorticoid injected. Otherwise, the active substance can enter 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 an increased susceptibility to infections), water retention in the tissues (edema), menstrual disorders and Cushing’s syndrome.

However, the likelihood of such side effects is higher if cortisone is internally in the form of tablets is applied. Such systemic cortisone therapy is therefore only an option in severe, extensive cases of circular hair loss. In most patients, it actually allows the hair to grow again. For this, cortisone must be taken in the long term in a dosage that can trigger the above-mentioned side effects. If the cortisone dose is then reduced or the medication is completely discontinued, the hair loss starts again.

Topical immunotherapy for circular hair loss

The effectiveness of local immunotherapy with the active ingredient diphencypron (diphenylcyclopropenone, DPCP) for circular hair loss is scientifically proven. This method is only used for larger bald herds:

First, the active ingredient is applied in a highly concentrated manner to the bald areas. It is there to trigger inflammation and sensitize the patient’s immune system to the active ingredient. After three to four weeks, DPCD is reapplied in low doses, which then causes an allergic skin irritation. The application is repeated weekly, usually for months.

Experts believe that this allergic skin inflammation on the bald scalp areas attracts certain immune cells that "displace" those immune cells that attack the hair root cells. In favorable cases, hair growth begins after about three months, with pigmentless (white) hair initially sprouting. A few weeks later, pigments are usually stored in this hair, but sometimes the new hair remains white.

Topical immunotherapy can actually make hair grow again in around 80 percent of patients with circular hair loss. However, almost every second patient will relapse (shortly after the end of therapy). In the long run, 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 phototoxically effective psoralen (such as methoxalen) is applied to the affected skin areas. 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 successful for 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 therapy variant is no more successful than the local PUVA. On the other hand, it carries a higher risk of skin cancer.

Zinc against circular hair loss

Zinc supplements 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 only rarely helps with circular hair loss. At least it has no side effects.

Support groups for circular hair loss

A surprisingly successful “therapy method” is participating in a self-help group: Patients with circular hair loss benefit from working together on the disease with other sufferers. Especially in children, participating in a self-help group can be more successful than any drug treatment.

Alternative healing methods against circular hair loss

Sometimes patients with circular hair loss use homeopathy, Schüßler salts and other alternative healing methods. Although their effectiveness has not been scientifically proven, an attempt in general cannot hurt.

For example, homeopaths with alopecia areata recommend taking Arsenicum album, Lycopodium clavatum, Phosphorus or Vinca minor. No. 5 is considered a suitable Schüßler salt Potassium phosphoricum. But also other means like No. 11 Silica or No. 21 Zincum chloratum should help with circular hair loss.

Circular hair loss: forecast

The course of circular hair loss is not predictable. In general, the prognosis is better in children than in adults.

In many cases, circular hair loss heals unexpectedly on its own. The re-growing hair is initially very fine and colorless, later it usually shows the usual strength and color. Sometimes this spontaneous healing is permanent, in other cases it is only temporary – the hair falls out again.

The chances of success of the different therapy methods are very changing. In general, treatment is more likely to succeed if the circular hair loss has not lasted for very long. The forecast is unfavorable for bald spots that are three years or older.

When the hair grows back during treatment, it is usually pigmentless (white). Those affected can then have spots of white hair on their heads, which doctors call poliosis. In some cases, relapse occurs later and the hair falls out again.

Some sufferers ultimately decide to wear a wig – especially if the circular hair loss affects the entire head.