| By :
Danny Grant
Alopecia Areata often responds to topical steroids. When we hear the word steroids, our minds usually jump to images of fake-tanned body builders standing in uncomfortable looking poses. The word steroid, when used in that context refers to anabolic steroids. Male sex hormones that help lay down muscle mass. It is much less confusing when we examine the action of both types of hormones in detail. The human still possesses the same fight or flight response needed in the animal kingdom. Logically those animals that were able to defend themselves well or run from danger are the ones that will have passed along their genetic material more efficiently than those that were killed through a weak stress response. We often forget that we evolved from the animal kingdom and share many common features with animals. Male animals usually display their dominance by fighting and in the dry conditions in which the human evolved, a lowering of the immune response is an efficient way to avoid an allergic reaction to the dust that is kicked up during scuffles. The body therefore makes a short term survival decision that overrides longer term health consideration. For example blood is diverted away from digestion and directed to muscles as there is no point in wasting energy digesting your lunch at the point you are likely to become someone else's lunch ! Cortisol is the adrenal hormone that helps us suppress our immune and allergic responses. Hence drugs that mimic our corticosteroids can be used for such suppression. It is thought that alopecia areata is caused by a proliferation of immune cells attacking the hair follicles in the area of the hair loss. So technically it is a malfunction of the immune system not a problem with the hair. Steroids are used topically (applied to the patch directly) and aim to suppress the immune system in the area of their application. Steroids have been with us for 60 years and whilst they may still be administered by injection as they were initially, topical versions are also available in the form of cream and gels to try to avoid the side effects associated with long term systemic exposure. The likely chance of a negative reaction increases the longer the steroid is used, because more is likely to be transported away from the area of application. Similarly the size of the area treated and the strength of the steroid prescribed can also bring about the following: 1) Alterations in the pigmentation of the skin 2) Alterations in the thickness of the skin which may cause it to leave stretch marks 3) Enlarged capillaries that cap be seen on the surface of the skin. 4) An allergic response to the treatment. 5) Bruised skin 6) As the immune system has been depressed, infections can take hold. More serious side effects like growth problems in children and Cushing's syndrome, can come about if larger areas are treated over prolonged periods. Doctors therefore like to start off with milder strength steroids Parents in particular worry when they see the list of potential side effects when using steroids to treat alopecia areata.
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