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Living with the Uncertainty of Alopecia Areata

I first started noticing hair loss in February of 2020. Whenever I showered or brushed my hair it seemed like I clumps of hair were falling out. By the end of that month I noticed a spot on the top of my head that was completely bald as I was combing my hair after a shower. Of course I was mortified because my hair had always been one of my favorite features. I freaked out about it and after calming down decided it wasn't that noticeable and I could cover it with other pieces of hair. The spot wasn't very big and I could conceal it well enough that I kind of put it on the back burner. At the time I was dealing with a lot of other health issues and a small bald spot seemed like the least of my worries.

It wasn't until January of 2021 that I got my health under enough control that I could make my hair loss a priority. I was able to see a dermatologist at the Mayo Clinic. At my first appointment he examined the spot and determined that I was most likely dealing with Alopecia Areata. A diagnosis I was expecting because like a normal person I googled my hair loss the year prior when I had first noticed it and decided that was probably what it was. The plan was to give me steroid injections which would reduce inflammation and suppress my immune system. I didn't notice any hair growth in the four weeks between my appointments. I though it might be normal, but when I went in for my follow up in February my doctor explained that there should at least be some regrowth. He still wasn't too worried and decided that it was probably just a stubborn case. We did more injections and I was told to follow up in another month. After the second round of injections I still did not experience any hair regrowth. My follow up in March was the first appointment he began to bring in other doctors from the department to consult. He had become concerned he might be missing something and decided to do two biopsies to look for discoid lupus. The biopsy procedure consisted of taking two small skin cutouts from the bald spot on my scalp. The results from the biopsies showed no signs of discoid lupus and I was told we would continue to treat for Alopecia Areata. At my next follow up in April we did more injections and decided to add on a topical steroid to apply daily since there was still no regrowth. By May it had started to become a routine, I would go in for my appointment and see my doctor and the other doctors he had consulting that day. They would discuss possibilities and theories for why my hair refused to grow back and then I would be given more injections. They also decided to add on another topical so that I would be applying two a day to try to get hair regrowth. By July there had been no signs of regrowth and I had been given five rounds of injections. I was told that even in the most stubborn cases of Alopecia Areata three injections was enough to bring about hair regrowth. Not to mention I was also using two different topicals daily. They started to feel like it could be a scarring alopecia and decided to do another biopsy to make sure they hadn't missed anything the first time. The results of the biopsy showed inflammation, but no evidence of scarring alopecia or discoid lupus.

After receiving the results of my recent biopsy they have decided to treat my alopecia more aggressively in hopes of sparking hair regrowth. The plan is to continue the injections and topical while adding an oral steroid for a month. I am supposed to go back at the end of August and I am hopeful I will have some improvement. I am optimistic that this will work especially after finding no evidence of scarring. If all of this doesn't work there are still more treatment options left. The spot honestly doesn't bother me too much because of its location and the fact I am able to cover it with some of my hair. I do worry though because at my appointment in July we compared my spot to images taken at prior appointments and determined that it had gotten bigger. This concerns me because we still don't know for sure why my hair won't grow back and until we do we can't really prevent it from spreading. I am staying positive and trying to remember that it is out of my control. However, it does get harder to remain positive and confident after leaving each appointment with no regrowth and more questions than answers. I keep my fingers crossed and hope for the best at my next appointment in August.


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