"You have a bald patch", informed the barber casually during the haircut. Maheshbhai went home and checked his scalp. Sure enough, there was a round area completely devoid of hair, smooth as a baby’s bottom! Panic gripped Maheshbhai who had never seen anything like this before. His mother saw the patch and comforted him. "This is 'undri', beta. It is caused by some worms that eat away the hair. Just apply garlic juice for a few days. This will kill the germs and soon your hair will grow back," she assured him. Obedient son that he was, he did as instructed. He had some stinging initially that he ignored. Soon the burning intensified and he got a raging rash with blisters on many parts of the scalp. The bald patch in this story is a condition called alopecia areata (AA) and what followed was a severe irritant reaction to garlic.
What is Alopecia Areata?
AA is an autoimmune disorder where the body launches an immune response against its own hair follicles. The tendency to develop this condition may be genetic in some people. In quite a few cases, AA is triggered off by highly stressful situations. Some patients have other autoimmune phenomena simultaneously, particularly antibodies directed against the thyroid gland.
There may be one or two patches of AA or some people may develop multiple patches. It can be embarrassing when large patches occur or eyebrows and eyelashes are affected. Men are distressed when half a moustache is lost. A very small perctentage of people may lose hair all over the scalp or even all over the body.
Making the hair grow back
A single patch of AA will regrow hair within six months to one year even without treatment. There are many options for treating AA. But none of them is uniformly effective. A popular folk solution is application of irritants like juice of onion and garlic. Sometimes even the services of jamalgota (croton oil) are employed. The irritation seems to stimulate regrowth of hair. Unfortunately the irritation can sometimes go out of hand.

The course of AA and the response to treatment is unpredictable and varies from person to person. Till hair grows back completely, it is often a good idea to camouflage the spots. Wigs or patches improve the appearance considerably. Masking the eyebrows with an eye pencil can make the face much more presentable. Men may be forced to go for a clean shave if they have beard or moustache involvement.

A dermatologist will choose the right combo of immune response modifiers, hair growth stimulants, irritants and contact sensitizers to handle the situation. Remember to give at least 2 to 3 months before discarding a treatment modality as useless.

A valuable information resource for patients with extensive alopecia areata is the National Alopecia Areata Foundation