When her husband, Will Smith, slapped comedian Chris Rock during the Oscars on March 27, Jada Pinkett Smith caught herself in the middle of a controversy. Pinkett Smith has stated that her shaved head is a political statement, and Rock made a joke about it.
Alopecia areata is a condition that Pinkett Smith has spoken openly about on her Facebook Watch show, “Red Table Talk,” on June 1. Based on the National Alopecia Areata Foundation, alopecia areata is an autoimmune disorder that can result in bald patches on the scalp and elsewhere. The immune system of a person with alopecia is misdirected and attacks the hair follicles, effectively halting hair development.
These follicles shrink severely, decrease hair development to a crawl, and fail to produce new, visible hair for months to years.
Small, smooth bald patches appear on the scalp, usually beginning in childhood. According to Dr. Brett King, an associate professor of dermatology at Yale School of Medicine, alopecia areata is distinct from the more prevalent kind of hair loss known as androgenetic alopecia, which similarly affects both men and women. Androgenetic alopecia occurs when hair follicles in the scalp become overly sensitive to dihydrotestosterone. This hormone is necessary for normal hair growth but inhibits hair growth on the scalp.
Sunday night’s events have piqued the public’s interest in the disease, which affects 6.8 million Americans and 147 million individuals globally, regardless of gender or ethnicity. Others who have dealt openly with alopecia areata include Representative Ayanna Pressley of Massachusetts and “Doctor Who” actor Matt Lucas.
What causes alopecia areata?
Alopecia areata has a genetic basis; thus, those who suffer from it are likely to have a family history of hair loss. However, as with other genetically predisposed disorders, the activating or suppressing mechanisms underlying the condition remain unknown. When one member of a pair of genetically identical twins has alopecia areata, the risk of that condition developing in the other member of the pair is roughly 50% at most. So, once more, the disease’s on/off cycle is triggered by factors outside our current understanding.
The hypothesis that stress, sadness, anxiety, or the environment plays a role in the development of the disease has been around for quite some time. However, there is a shortage of solid proof of this. Although stress can exacerbate the symptoms for some people, it is not the root reason.
This may manifest in the nails because keratin, a protein, is also found in hair. Most commonly, nail problems manifest as pits, which look like the nail surface was repeatedly pricked with a needle. Nails can sometimes become extremely tough and/or brittle; in extreme cases, they can fall off.
Alopecia areata typically causes patchy hair loss, which might be the size of a dime or a half dollar. Spots like these usually disappear after therapy, but sometimes they disappear on their own. Some folks may have those spots disappear while others get new ones. Rarely, in maybe 10–25% of patients with alopecia areata, those patches will lead to significant hair loss or no hair over weeks, months, or years.
Is the hair loss permanent?
Factors determining whether someone experiences minor illness symptoms or severe hair loss are unknown. Alopecia areata is terrifying for people because of how erratic the hair loss may be.
In cases of alopecia areata, hair loss can be treated successfully. The loss of hair may be irreversible if it has been gone for an extended period of time.
Spots of hair loss caused by alopecia areata are unexpected, and even if they disappear now, they could return in three months, three years, or 30 years from now. The good news is that we can predict with a fair amount of certainty that most people will have a relatively small number of spots that will appear and just go.
It could be a disfigurement to those who suffer from alopecia areata. Would you still have gone to Starbucks if you woke up today minus some or all of your eyebrows? Or, you would have gone into hiding, seeking explanations for your problems.
Personality and sexuality can be shown through one’s hairstyle. If you look for “evolution” on Google, you’ll see pictures of hairy Neanderthals at the top of the results. We gradually lost hair everywhere but on our heads and faces, and there’s a logic for evolution doing that. A lot is riding on the hair on our heads.
Hair loss is devastating; it’s clear. Alopecia areata, where there is less than 30% of the hair on the scalp, cannot be concealed. People who knew you yesterday don’t recognize you today since you don’t resemble who you used to be at all. Identifying someone requires a close examination of their eyebrows. Additionally, what disease do people believe you have? For some reason, whenever you see a poster featuring a lady who has lost her hair or is covering her head with a scarf, you immediately assume she has cancer and is receiving chemotherapy. Shaving one’s head has traditionally been used as social punishment. Lots of information can be found inside a single strand of hair. Because of such a severe deformation, the discomfort is excruciating.
So, what is the treatment?
We can treat bacterial infections as well as viral infections like Covid-19. However, just like with any other autoimmune condition, alopecia areata cannot be cured.
However, with alopecia areata, things are somewhat different because we historically haven’t had any treatments that work. Tofacitinib, a member of a class of drugs known as JAK inhibitors, was previously unknown to be effective against severe alopecia areata until the case of a young man was reported.
He suddenly had full hair again. This treatment was implemented due to growing evidence that JAK inhibitors can halt the pathogenic processes that lead to an immune system assault on hair follicles. The report encouraged the pharmaceutical industry to focus on creating therapies for alopecia areata, giving patients hope for a cure.
JAK inhibitors are presently being tested in phase III clinical trials for alopecia areata, and the results are very encouraging. We are on the cusp of something very monumental. For the first time in medical history, we hope to improve the lives of those with severe alopecia areata by reversing the illness.
Most of these individuals have been told there is no cure, that they should be grateful that it is not cancer, or that it is “only hair.” But today, there is a chance for the treatment of this terrible illness.
Many of these patients’ lives will be transformed due to these treatments. Many people and their families can relate to your pain. Pick a dermatologist willing to spend time with you answering your questions and explaining whether or not these treatments could benefit you. But please don’t accept the consolation that “at least you don’t have cancer.”
Let’s not stop until everyone has access to effective treatment.
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