Key Points
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Alopecia areata is a sudden loss of hair. It is an autoimmune condition in which the person's own immune system attacks the hair follicles.
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Alopecia areata is patchy hair loss while alopecia totalis is more extensive or total loss of hair.
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Alopecia areata is more common in people with Down syndrome compared to people without Down syndrome.
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Newer treatments focus on reducing inflammation and/or the function of the immune system.
What is alopecia areata?
Alopecia areata is loss of hair that occurs suddenly but can become chronic. It is an autoimmune disease in which the body’s immune system attacks the hair follicles. Alopecia areata is the patchy loss of hair. Alopecia totalis is a type of alopecia areata in which hair loss occurs diffusely from the scalp, face, and other parts of the body.
Alopecia areata is highly unpredictable. People who have this disorder may experience several episodes of hair loss and regrowth throughout their lifetimes while others may experience only one or two episodes.
Alopecia areata and Down syndrome
Like many autoimmune conditions, alopecia areata is more common in people with Down syndrome. Studies evaluating frequency are limited, but figures vary from 1.3% to 21% in people with Down syndrome compared to 0.1% to 0.2% in people without Down syndrome. One study reported an average age of onset of 7 years in people with Down syndrome.
Diagnosis
The diagnosis starts with a history and physical to assess for the findings that are commonly part of hair loss related to alopecia areata or totalis. Additional testing may be done for other conditions that can cause hair loss. More information is available in this Possible Causes of Hair Loss article.
Treatment
There are several treatment options for alopecia areata. Some of the more common options are described below.
Steroids
Alopecia areata can be treated with steroid injections or high potency steroids. However, research has shown limited benefit.
Topical minoxidil (Rogaine)
Topical minoxidil (Rogaine) may provide some benefit. Minoxidil works to increase hair growth by accelerating the natural hair cycle. Usually, it takes several weeks of treatment before hair growth is seen.
JAK inhibitors
Reducing inflammation or reducing the effect of the immune system may be effective. Janus Kinase (JAK) inhibitors are oral immunotherapy medicines that reduce inflammation and are used to treat a variety of autoimmune conditions. They have been shown to increase regrowth by more than 75% in people without Down syndrome who have alopecia areata. A small study in people with Down syndrome showed that JAK inhibitors are also beneficial for people with Down syndrome. Additional studies are in progress:
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The University of Colorado completed a study on the use of a JAK inhibitor called tofacitinib by people with Down syndrome. Publication of the results is anticipated/pending.
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The Icahn School of Medicine at Mount Sinai in New York received a grant to study alopecia areata in people with Down syndrome.
Other considerations
Patients who do not wish to pursue medical treatment may benefit from cosmetic treatments such as wigs.
Emotional support is also important. Having alopecia areata can lead to insecurities about one's physical appearance. Having a strong support system and validation about one's appearance is crucial to helping one embrace his/her physical differences. Some individuals and their families also benefit from participating in support networks through organizations such as the National Alopecia Areata Foundation.
Additional treatments are described on the American Academy of Dermatology Association website.
Resources
Down syndrome
Possible Causes of Hair Loss
General
Alopecia Areata (Cleveland Clinic)
Alopecia Areata Diagnosis and Treatment (American Academy of Dermatology Association)
What is alopecia areata? (Mayo Clinic)
How is alopecia areata treated? (Mayo Clinic)
References
Rachubinski AL, Estrada BE, Norris D, Dunnick CA, Boldrick JC, Espinosa JM. Janus kinase inhibition in Down syndrome: 2 cases of therapeutic benefit for alopecia areata. JAAD Case Rep. 2019;5(4):365-367. Published 2019 Apr 5. doi:10.1016/j.jdcr.2019.02.007
Ramot Y, Molho-Pessach V, Tenenbaum A, Zlotogorski A. Alopecia areata and Down syndrome: A true association or a coincidence. Int J Trichology. 2013;5(4):227-228. doi:10.4103/0974-7753.130425