Eyebrow and Nose Hair Alopecia

[sa86]

Hi,

I am  24 year old female, and about 6 months ago I noticed my eyebrow hair falling out. All the hair didn't completely fall out, but was noticeable and the problem pretty much resolved within a month or two. About two weeks ago, I started experiencing the same thing, went to the dermatologist and she diagnosed me with alopecia areata. She explained to me the nature and unpredictability of the disease and gave me some steroid shots. Tonight I noticed that my nose hairs had fallen out too.

My question is this: I know that this condition is unpredictable but that certain risk factors are associated with developing severe alopecia and alopecia totalis/universalis. Of these, I do have allergic rhinitis but it is not horrible (unless I am around cats), i do not have other forms of atopy. Now that the condition has spread to another part of my body (nose), I was wondering if I am falling into the category for a poor prognosis. I have had no loss of my scalp hair throughout this ordeal.

Any help with this problem would be greatly appreciated, I'm becoming very very worried and I just want to have some idea of what might happen. I just want some type of explanation of different manifestations of alopecia areata and where I fall into that, and what the typical prognosis is. I can't seem to find anything dealing with only eyebrow/nose hair involvement.

Thank you so much!

[Jasmina Jankicevic, MD, MSc, CCRP]

Description you provided indicates that you have a mild form of alopecia areata.

Alopecia areata (AA) commonly presents as one or more patches (often round or oval) of non-scarring (hair follicles stay alive) hair loss. Even though AA has sudden onset, recurrent episodes, and unpredictable course, hair re-growth may occur even without treatment and even after many years.

There are several treatment options (not all work for each patient) available for mild, patchy alopecia: intralesional corticosteroids (these injections are often helpful in treatment of eyebrows), topical corticosteroids, topical minoxidil, anthralin cream/ointment, and.

Other clinical presentations of AA include alopecia totalis (loss of all scalp hair), alopecia universalis (loss of all body hair), ophiasis pattern (hair loss in the back of the head area), reticular variant (hair loss in one area with concurrent hair re-growth in another site), and diffuse variant (widespread hair thinning).  

In regards to prognosis, recent studies have highlighted possible factors that may predict poor outcomes in alopecia areata. These include severity at initial presentation, onset in childhood, associated autoimmune disease (atopy - allergic rhinitis, atopic dermatitis, and/or asthma; Hashimoto’s thyroiditis, vitiligo, inflammatory bowel syndrome, autoimmune polyendocrinopahy syndrome 1, etc.) The role of low serum iron/ ferritin in triggering AA is still controversial, but it is worth checking.

In future, you might find the website of the National Alopecia Areata Foundation useful to inform yourself about the latest research, different support options, resources, etc.

And, please, stop worrying! I know, it is easier said than done, but being preoccupied with “what ifs” and worst-case scenarios want make things better, on the contrary. Alopecia areata is an autoimmune disease, and stress is now heavily studied as a possible major trigger of autoimmune processes.  

Yours in optimal health,
Dr. Jasmina Jankicevic

[sa86]

Correction: Not all my nose hairs, just a few