Alopecia, the expert explains the alarm bells and the causes of the disease that struck Will Smith’s wife

The scene made by Will Smith at the night of the Oscars – to defend his wife Jada Pinkett Smith suffering from alopecia – has focused the objectives on a problem, which affects not only men but also women with increasing percentages. According to a recent study by Sanders, in fact, 4 million Italians suffer from alopecia (one in four women) with a higher incidence – depending on the type – in postmenopausal women.

Benedetta de Mattei interviewed Bianca Maria Piraccini – Professor of Dermatology at the University of Bologna and Head of Allergology and Skin Adnexa Diseases of the Dermatology Clinic of the Sant’Orsola-Malpighi Polyclinic of Bologna – to understand what alopecia is, who it affects and what are the causes.

What is alopecia and how many people does it affect?

In the case of Will Smith’s wife there is talk of a specific hair disease, alopecia areatawhich affects about the 2% of the general population. It’s a autoimmune disease of the hair follicle, characterized by a failure of our immune defenses that fight our hair follicles mistaking them for strangers. Alopecia areata it can appear at any age in both males and females and induces more or less severe acute hair loss. In mild forms, circular hairless patches form but the entire scalp can be affected with total alopecia areata and sometimes even all body hair falls out including eyelashes, eyebrows, beard and hair.

How is it different from the more common baldness?

There baldness (or androgenetic alopecia) is a disease where it is a genetic predisposition is important: we inherit the fact that the hair follicles of some areas of the head – in the vertex area, in the anterior area and in the temples – are affected a little too much by androgens and therefore become thinner, producing thinner, shorter and lighter hair. Baldness appears above all in the male already at 20-25 years with a receding hairline or the so-called ‘chierica’. In women less and the thinning is widespread at the top of the head, with the hairline preserved. This is the most frequent hair disease, both in males and females, with an incidence of up to 50% in males in their fifties, growing with age while the prevalence in women is about 20-30% , especially after menopause.

There are different forms

With the term alopecia are included different shapes, because the name “alopecia” generally means hair loss. L’androgenetic alopecia is the most common form, but there are others, such as cicatricial alopeciathe telogen effluvium. Talking about alopecia areatatherefore of the specific pathology of Will Smith’s wife, or the autoimmune disease affecting the hair follicles, there are different forms, based on the extent: we can have a involvement of the scalp with hair loss in patches, or the loss of all hair (called total alopecia areata), or the loss of all hair and hair (alopecia areata universal), or you can see one alopecia areata circumscribed of some areas such as eyebrows, eyelashes and beard, which suddenly become hairless.

What are the causes and risk factors of alopecia?

According to the type of alopecia there are different causes. In the case of the telogen effluviumthat is, of the slight and diffuse hair loss, without visible thinning, the causes may be the taking some medicationsi thyroid disordersthe iron deficiencythe weight lossor le hormonal changes following pregnancy or menopause. In these cases, hair loss stops if the triggering cause is removed. Alopecia areata is an autoimmune disease, so the cause is a tendency of our lymphocytes – that is, our defense cells – to miss target by attacking the hair follicles as if they were foreign. There is often one genetic predisposition to diseases autoimmune and frequently these patients also suffer from other autoimmune diseases such as thyroiditis or celiac disease. Among the triggering factors that at a certain moment of life cause alopecia areata to appear in those who are predisposed, there are events that can affect the immune defenses such as, for example, viral diseases or vaccinations. But none of these factors has ever been associated with absolute certainty with alopecia aerata, which often appears without any triggering event occurring.

How to recognize it?

Each form of alopecia has gods characteristic clinical symptoms. If you notice a leak sudden hair superior than normal, when we wash them, comb them or pass our hands, it is important to contact a dermatologist to diagnose the causes of telogen effluvium and proceed with the most appropriate treatment. The slow and progressive appearance of a thinning of the hair at the top of the head is instead typical of androgenetic alopecia, which in the male is associated with receding of the temples and thinning at the vertex: also in this case the dermatologist is the reference specialist, able to prescribe specific and effective drugs for this problem. The very rapid appearance of 1 or more roundish patches completely devoid of hair or the acute loss of all hair is typical of alopecia areata.

What are the best solutions to combat airborne alopecia?

Treatment of alopecia areata must aim at reducing the aggression against the hair follicle from our defense inflammatory cells and therefore corticosteroids are mainly used, administered in various ways: applied locally, injected with patches or generally. This is usually the first choice therapy, which obviously must be prescribed by the dermatologist who visits the patient, ascertains the diagnosis and prescribes the therapy, explaining well the dose and duration. While in the mild forms of aerated alopecia regrowth can occur without any treatment, generally within a year, the more severe forms often have a chronic-relapsing course, with regrowth and exodus of relapse of the hair.

Benedetta de Mattei

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Alopecia, the expert explains the alarm bells and the causes of the disease that struck Will Smith’s wife


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