Alopecia and Thyroid Disease

Patient Expert
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Alopecia is the medical term for hair loss. Hair loss is a common thyroid symptom. Specifically, the type of hair loss seen in hypothyroidism includes loss of scalp hair and loss of hair from the outer edge of the eyebrows.

Thyroid-related hair loss is often resolved with optimal treatment of the underlying hypothyroidism. Thyroid disease is also linked to an increased risk of the most common type of hair loss, the hormonally-driven androgenetic alopecia, also known as male pattern baldness or female pattern baldness.

There are several types of alopecia that are categorized as autoimmune diseases. With the autoimmune forms of alopecia, your immune system mistakenly attacks your hair follicles, where your hair is made, causing hair loss. According to the National Alopecia Areata Foundation, around 2 percent of the population — or almost 7 million people in the United States — have some form of autoimmune alopecia.

People with an autoimmune thyroid disease such as Hashimoto’s thyroiditis or Graves’ disease are at higher risk of the autoimmune forms of alopecia. Similarly, there are higher rates of autoimmune thyroid disease in people with autoimmune alopecia, when compared to the general public.

Four key types of autoimmune alopecia

There are four key types of autoimmune alopecia:

  1. Alopecia areata: Alopecia areata is an autoimmune disease that causes patches of hair loss, most commonly on the scalp. It is the most common type of alopecia. Alopecia areata usually shows up as small, circular bald patches, about the size of a quarter. Some people have just one or two patches; others may have more widespread and extensive patches of hair loss on the scalp.

  2. Alopecia totalis: Alopecia totalis is a more advanced form of alopecia areata. Typically, all hair on the scalp is lost. It is less common than alopecia areata and makes up about 5 percent of all autoimmune alopecia cases.

  3. Alopecia universalis: Alopecia universalis is the most advanced and least common type of autoimmune alopecia. Typically, all the body hair is lost, including hair from the scalp, eyelashes, eyebrows, limbs, and torso. It makes up only 5 percent of autoimmune alopecia cases.

  1. Alopecia barbae: Alopecia barbae involves small, circular patches of hair loss on the beard area.

The risks of autoimmune alopecia

Your risk of developing autoimmune alopecia is higher if:

  • Members of your family have a history of any autoimmune alopecia or other autoimmune disease, including autoimmune thyroid disease
  • You have autoimmune thyroid disease or another autoimmune disease

Stressful events also appear to be a factor, and research shows that about 10 percent of adults and up to 80 percent of children experienced a highly stressful event right before the onset of autoimmune alopecia.

Age is also a risk factor. The majority of people with autoimmune alopecia are diagnosed by the age of 40, but the disease can occur at any age.

Symptoms of autoimmune alopecia

Autoimmune alopecia does not typically cause any pain or illness, and it’s not contagious. The primary symptom is hair loss, specifically, circular patches of hair loss on the scalp or beard, or in more advanced cases, total loss of scalp hair, or all body hair.

According to the American Academy of Dermatology, nail problems are also common in autoimmune alopecia, especially dents, pitting, ridges, lines, and white spots on your fingernails or toenails. More significant nail changes are more commonly seen in cases of alopecia totalis and alopecia universalis.

Treatment of autoimmune alopecia

There are no known cures for the various types of autoimmune alopecia. It’s estimated, however, that as many as two-thirds of people with autoimmune alopecia will spontaneously regrow their hair within two years, even without treatment. At the same time, autoimmune alopecia may also recur after hair has regrown.

Treatment for autoimmune alopecia focuses on helping hair regrow more quickly, and to prevent a recurrence of the hair loss. The following are some of the treatments.

Corticosteroids: Corticosteroid creams are applied topically, or corticosteroids are injected into the areas of hair loss every four to six weeks to help stimulate hair to regrow in the bald patches. Study results differ, but recent research has shown significant regrowth in as much as 70 percent of patients using corticosteroids.

Minoxidil (Rogaine): Minoxidil is applied to affected areas to help stimulate regrowth. According to research, topical minoxidil solution (5 percent) may stimulate regrowth in up to 80 percent of patients who have significant scalp hair loss due to autoimmune alopecia.

Anthralin: Anthralin is a cream, also known as dithranol, and goes by the brand names Dithrocream, Zithranol, Psorlin, Dithro-Scalp, Anthraforte, Anthranol, and Anthrascalp. This prescription drug is applied to affected areas to help stimulate regrowth. There are not many studies on anthralin, but recent research suggests response rates of 25 to 75 percent, with better response seen in patients with patchy alopecia areata, versus alopecia totalis or universalis.

Diphencyprone: Diphencyprone is an experimental immunotherapy drug that is topically applied to affected areas. It has had fairly significant success in studies, especially with more severe forms of alopecia, such as alopecia totalis and alopecia universalis. Diphencyprone is not approved by the U.S. Food and Drug Administration but has been used in several studies.

Immunosuppressants: Two drugs, methotrexate — a chemotherapy drug and immunosuppressant — and cyclosporine — a drug used to prevent organ rejection after transplant — have been studied and found to have some success. Both drugs stimulated hair regrowth in about half the patients studied. These drugs can have significant side effects, however, including diarrhea, nausea, and fatigue.

Psoralen with ultraviolet A light: Known as PUVA, this therapy is the combination of a medicine, psoralen, with topical UVA light therapy. Psoralen is taken orally or applied topically, and UVA light treatments are done over a four- to six-month period. While results have been mixed, several studies have shown a significant response and hair regrowth in some patients.

Natural Approaches: On the natural front, there are some potentially promising options for autoimmune alopecia:

  • Korean red ginseng can help improve regrowth rates when taken along with corticosteroid injections.
  • Zinc deficiency should be evaluated and supplemented if a deficiency is found, as zinc levels correlate with severity of autoimmune alopecia.
  • The anti-inflammatory supplement quercetin may help stimulate regrowth and prevent a relapse of autoimmune alopecia.
  • Applied topically, lavender oil may help encourage hair regrowth and reduce follicle inflammation.
  • A combination of essential oils, including thyme, rosemary, lavender, and cedarwood massaged into the scalp may be as effective as the drug minoxidil at stimulating regrowth.

A promising new option?

One promising new option is the use of the prescription drug low-dose naltrexone, known as LDN, for autoimmune alopecia. This prescription drug is being used by integrative physicians to help modulate the immune system for a variety of autoimmune diseases, including alopecia. The LDN Research Trust has information on patients who have used LDN for alopecia. You can join a Facebook community that focuses on LDN and natural treatments for alopecia. You may want to learn more about the use of LDN for autoimmune diseases in patient advocate Julia Schopick’s book, “Honest Medicine.”

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