Is autoimmunity the most important cause of hair loss in alopecia areata ?
Many journal reports introduce the subject with a phrase along the lines of “the etiology of alopecia areata is entirely unknown” (eg Price 1991, Perret 1984, Paus 1993). Indirect evidence points towards hair loss being a result of immune system activity – an autoimmune disease. The evidence primarily consists of observation of an immune cell infiltrate in and around dystrophic hair follicles and the knowledge that some people with alopecia areata can regrow hair when undergoing immunosuppressive therapy (eg Gupta 1990). Further evidence comes from the association of alopecia areata with other autoimmune diseases. However, a small minority of dermatologists reject the idea of alopecia areata being an autoimmune disease. Indirect evidence provided in support of an autoimmune mechanism is not incontrovertible. There are many theoretically possible, pathogenic pathways that may elicit hair loss in alopecia areata and lead to expression of an immune cell infiltrate. They can be classed int
