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Antihistamines for Alopecia - An Overview

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Alopecia is an autoimmune (natural defense targets own tissues) disease targeting the body’s hair follicles, causing hair loss. Read the article below for details.

Written by

Dr. Saranya. P

Medically reviewed by

Dr. Filza Hafeez

Published At February 20, 2023
Reviewed AtNovember 24, 2023

What Is Alopecia Areata?

Alopecia is a general word for conditions that cause hair loss. One of the more prevalent forms of alopecia is alopecia areata. Alopecia areata occurs when the immune system destroys hair follicles. The structures of the skin that generate hair are called hair follicles. Although alopecia areata can affect any part of the body, the head and face are most frequently affected. Hair normally sheds in quarter-sized, spherical patches, but in certain circumstances, the amount of hair loss is more. The majority of patients have no other symptoms and are in good health. No two individuals have similarities in the symptomatology of alopecia areata. Some people have hair loss on and off throughout their lifetimes, while others only experience it once. Recovery is unpredictable; some individual hair fully regenerates while others do not. Alopecia areata cannot be cured. However, some therapies can hasten the growth of new hair. Resources are available to assist people coping with hair loss.

What Are Antihistamines?

Antihistamines are a family of medications frequently used to treat allergy symptoms. These medications aid in treating ailments brought on by an excess of histamine, a substance produced by the body's immune system. People who experience allergic reactions to pollen and other allergens are the ones who most frequently use antihistamines. They also treat many other illnesses, including anxiety, colds, and gastrointestinal issues. Recently studies have been conducted regarding the use of antihistamines in alopecia.

How Do Antihistamines Work?

Antihistamines function by preventing the action of histamine, the molecule that causes many allergic symptoms. Histamine is generated by various cells in the body. Mast cells, which are found where the body interacts with the environment outside, produce large amounts of histamine. When it is released, it binds to special spots on the cell called receptors leading to inflammation and other allergy symptoms. Antihistamines limit the effects of histamine by "coating" receptors, which inhibits binding. As a result, allergy symptoms are avoided.

Who Gets Alopecia?

About 2% of people will get alopecia areata in their lives. Children and adults with all skin tones and hair colors are affected. Most patients suffer onset before the fourth decade, and the second and third decades have the highest incidence. There is no explicit sex or ethnic preponderance in alopecia areata.

How Difficult Is It to Treat Alopecia?

Since it is difficult to find the exact cause of alopecia, it is difficult to find the treatment method and get it treated. Individuals may benefit differently from various treatments. There is not a single therapy that works for everyone.

How Is Alopecia Diagnosed?

Alopecia areata is normally diagnosed based on clinical characteristics, but further testing may help. Some of the diagnostic methods are as follows:

  • Trichoscopy: The hair follicle, hair shaft, and scalp are examined using dermatoscopy.

Exclamation point hair loss, broken or dystrophic hair, and yellow and black dots are signs of active disease.

  • Hair Pull Test: This can assist in determining hair loss and is frequently positive in alopecia areata. It involves providing light traction while holding 40 to 60 tightly bunched hairs. Positive if more than 10% of the hair is removed easily.

  • Skin Biopsy: A skin biopsy may be necessary if the diagnosis is unclear. The biopsy removes a small piece of tissue and is studied under a microscope for changes.

Why Antihistamines Help in Alopecia?

Allergy is considered one of the causes of alopecia since allergy and alopecia share the same genetic background contributing to an immune reaction imbalance. Thus, treating the allergic reaction will promote hair regrowth in allergic alopecia patients. Antihistamines, often used to treat allergy symptoms along with standard treatment, help treat alopecia.

How Antihistamines Help in Alopecia?

The effect of antihistamines on alopecia is still under study. Various studies are carried out in different places to determine the role of antihistamines in treating alopecia.

  • For instance, researchers from Japan recently described a 19-year-old lady with the ophiasis pattern of alopecia areata in the rear of her scalp and who responded better to antihistamine (Fexofenadine) treatment. Strong topical steroids were initially used to treat the young woman, but after four months, there was no change. Within three months of introducing Fexofenadine, a change was noticeable.

  • In a recent trial, researchers used antihistamines, topical corticosteroids, and superficial cryotherapy to treat alopecia areata, with promising outcomes reported in the American Academy of Dermatology journal.

How Is Alopecia Treated With Antihistamines?

Antihistamines are used with other treatment options, such as topical steroids. Antihistamines that are frequently used are Fexofenadine and Ebastine. These drugs improve the effect of other treatment options for alopecia. Antihistamines are available in various forms, such as liquids, lotions, creams, gels, and tablets.

What Are the Other Treatment Methods for Alopecia?

Although there is no known cure for alopecia, there are several treatments that could either help with hair growth or at the very least, delay or stop additional hair loss. Some of the more popular alopecia treatments are as follows:

  • Corticosteroids: Corticosteroids with a prescription strength can inhibit the immune system and lessen harm to healthy hair follicles. These drugs come in oral, topical, and injectable forms.

  • Microneedling: Micro-needling is relatively new for stimulating hair growth. The scalp is punctured with tiny needles to encourage collagen (a kind of protein) formation, which can restore hair growth during the procedure.

  • Minoxidil: Minoxidil, a regularly used drug, is available without a prescription. It is applied topically to regions where hair is thinning.

  • Stress Reduction: Hair loss brought on by extremely stressful situations can occasionally be stopped by learning to manage your stress and getting through particularly trying times in life. Diffuse alopecia areata is one kind of alopecia that may respond to adequate stress management.

  • Immunotherapy: Other drugs besides corticosteroids can reduce the body's immunological response. These include drugs used orally, such as Cyclosporine and Tofacitinib.

  • Platelet-Rich Plasma Injections (PEP): Blood plasma contains certain proteins that aid blood clotting. Additionally, it has proteins that help cells proliferate. Plasma from blood is extracted and concentrated on creating PRP. PRP injections into injured tissues are thought to encourage the production of new, healthy cells and accelerate recovery. PRP scalp injections could improve the scalp's health, improving the environment for hair growth.

What Are the Indications and Contraindications of Treating With Antihistamines?

Antihistamines combined with standard treatment methods are indicated in certain situations. Some of them are as follows:

  • Females between 20 to 50 years of age have androgenetic alopecia.

  • The patient has experienced active hair loss within the past twelve months.

  • Patients with androgenetic alopecia who have not been treated systemically or topically in the last six months.

  • Patients who use mild, non-medicated shampoo and conditioner.

Some contraindications are as follows:

  • Patients with chronic scalp conditions (psoriasis and infection).

  • Patients who underwent radiation therapy of the scalp or chemotherapy.

  • Pregnant or nursing women.

  • Patients who had hair transplants or scalp reduction procedures.

  • Patients with underlying medical conditions such as inflammatory bowel disease, thyroid disease, and connective tissue disease,

What Are the Side Effects of Antihistamines?

Some of the common side effects are as follows:

  • Drowsiness.

  • Dry mouth and dry eyes.

  • Blurred or double vision.

  • Dizziness and headache.

  • Low blood pressure.

  • Mucous thickening in the airways.

  • Rapid heart rate.

  • Trouble urinating and constipation.

  • Antihistamines are contraindicated in pregnant and lactating women since birth anomalies were demonstrated in animal tests, and they can be excreted through the breastmilk.

Conclusion

Alopecia is a long-standing condition that causes hair loss. Despite the disease's lack of major medical effects, it can have psychological effects on patients. People with alopecia areata can get support from groups to help them cope with the psychological effects of their condition. Alopecia is treated with various treatment modalities, and antihistamines' effect on alopecia is still under study. However, combined with other treatment methods, antihistamines have provided a positive prognosis in the treatment of alopecia.

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Dr. Filza Hafeez

Dermatology

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