Professor Celia Moss
Brief Outline: Professor Celia Moss is a Consultant Dermatologist (Birmingham Children’s Hospital). Her particular areas of clinical and research interests include paediatric dermatology and genetic skin disorders.
Background: Professor Celia Moss is a Consultant Dermatologist, Honorary Professor of Paediatric Dermatology and member of the British Society of Paediatric Dermatology. She was awarded an OBE in 2016 for her work helping young people with skin conditions.
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Professor Moss says alopecia areata does not cause scarring.
Professor Moss says alopecia areata does not cause scarring.
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Professor Moss talks about the prognosis of alopecia and likelihood of regrowth.
Professor Moss talks about the prognosis of alopecia and likelihood of regrowth.
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How about in term of recurrent hair loss? People who've had regrowth, and then if they have another patch develop?
Again, I think if it happens on several occasions again that would tend to make us think ‘this is-, it's gonna go on’. You know, it's really the past history that is informing us. So if it's already gone on for a long time, it's likely to continue. Whereas if it's very new, then there's a chance that it may recover. There are some patterns that actually are less likely to recover. And if people have it in what we call an ophiasis pattern and what that means is a band affecting the back of the head and over the ears, over the temporal regions, that tends to have a worse prognosis. That tends to be a bit less likely to regrow.
Professor Moss talks about the types of alopecia.
Professor Moss talks about the types of alopecia.
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Could you tell me how common the different types of alopecia are?
Alopecia areata affects probably about one in a thousand people, one to two in a thousand people. So actually relatively common. It's much rarer, I couldn't give you a figure for totalis and universalis, but I would say that of all people with alopecia areata, a very small proportion, probably less than five percent, have totalis. And probably only one percent of those have universalis.
Professor Moss explains about the causes of alopecia areata as an autoimmune condition.
Professor Moss explains about the causes of alopecia areata as an autoimmune condition.
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Sometimes we test for them, if there's a suggestion. So if someone with alopecia is totally healthy, leading a normal life, then we wouldn't do any tests. But if there's a suggestion that they might have some other medical problems, such as diabetes or thyroid problems, then we would test. We would look for the antibodies, and test. We don't routinely test for antibodies, because actually quite a lot of people have the antibodies and they’re not causing a problem. And in some ways it's better not to know, because they're there but they're not causing a problem. But that's the basic cause of alopecia.
Professor Moss talks about research on genetics and environmental factors for alopecia.
Professor Moss talks about research on genetics and environmental factors for alopecia.
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Professor Moss talks about possible triggers of alopecia areata.
Professor Moss talks about possible triggers of alopecia areata.
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Professor Moss talks about steroid treatments (creams, injections, tablets) for alopecia areata.
Professor Moss talks about steroid treatments (creams, injections, tablets) for alopecia areata.
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So if we’ve tried steroid treatment and it doesn’t work, then we might consider moving onto steroid injections. Now the problem with steroid injections is that they’re painful. And obviously the more you do, the more it hurts. And they only really work where you inject. It’s not like having a vaccination in your arm that affects your whole body. The steroid injections just work where you inject. So if you’ve got lots of patches and you want them all treated, then it’s lots of injections. We can use an injecting device which sort of squirts things into the skin under high pressure, without the needles. And you get several points injected at the same time. Which is slightly less painful than a needle, but it still hurts. So that’s the main drawback. It is more effective than a cream. It usually needs to be done on more than one occasion. So, each session there’d be several injections in all the places affected. Need to come back and have more treatments. See how it goes. If it’s working well, then we would continue, and if it’s not working at all after four or five injections we probably would advise not continuing.
Some people prescribe steroids by mouth. There’s no doubt that a course of high dose steroids does improve alopecia areata. But firstly the improvement is not always maintained, so when you come off it, which you have to do, the hair would stop regrowing and may come out again. And, of course, oral steroids have all sorts of side effects. And they can affect the body’s immune system. They can affect children’s growth. They can make people put on weight and gain fluid. And lots of adverse effects. So, in general, we feel that it’s not justified to give oral steroids for alopecia areata. But having said that, some people are so distressed by their alopecia areata that they’re very keen, even if it has side effects. So often that’s a difficult conversation to have with people, to try and make clear, make sure that they understand the risk-benefit ratio.
Professor Moss talks about minoxidil and says it’s not often prescribed by doctors.
Professor Moss talks about minoxidil and says it’s not often prescribed by doctors.
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Professor Moss talks about topical immunotherapy using the drug diphencyprone (DCPC).
Professor Moss talks about topical immunotherapy using the drug diphencyprone (DCPC).
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Professor Moss talks about immunosuppressant treatments for alopecia.
Professor Moss talks about immunosuppressant treatments for alopecia.
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Professor Moss talks about where people can get emotional support.
Professor Moss talks about where people can get emotional support.
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Professor Moss explains the NHS allowance for wigs.
Professor Moss explains the NHS allowance for wigs.
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