How long has humanity known about alopecia areata?

Alopecia areata (AA), a condition characterized by sudden hair loss in patches, has a long-standing history, with descriptions seemingly present in ancient texts and visual arts. This article endeavors to explore the early history of this condition, tracing its roots from ancient civilizations to the modern scientific understanding we have today.

The earliest potential reference to AA can be traced back to the ancient Vedas (5000-400 BCE) of Ayurvedic medicine. However, confirming this with certainty is challenging due to the chronological ambiguity of these texts. A more definitive historical record of AA appears in the “Ebers Papyrus,” the most comprehensive record of ancient Egyptian medicine known to date, believed to be from around 1500 BCE. This papyrus, found nestled between the feet of an Egyptian mummy, primarily lists medical treatments for use in the afterlife. Within the text, a condition termed “Nssq,” which indicates hair loss, is mentioned. It is believed this term refers to patchy AA, providing the earliest reasonable evidence of this condition.

The Greek physician Hippocrates (~400 BCE) briefly mentioned hair afflictions in his book “On Diseases.” He referred to areas where the hair was “foxy” (from the Greek αλώπηξ = alopex, meaning fox’s disease, alopecia), potentially alluding to mange. It remains unclear, however, if he was describing AA or androgenetic alopecia.

In ancient Chinese texts, the Yellow Emperor Huang Ti (2696-2595 BCE) suggested that hair could fall out due to imbalanced dietary practices. These writings may also refer to AA, although it is not entirely clear.

The first unmistakable descriptions of AA are credited to Cornelius Celsus (25 BCE – 50 CE), a Roman translator of medical works. In his work “De Medicina,” he described “Alopekia,” bald spots appearing on the scalp and beard, and “Ophiasis,” bald areas spreading in a pattern reminiscent of a winding snake.

The Italian physician Girolamo Mercuriale (1530-1606) later echoed these ancient descriptions in his book “De Morbis Cutaneis” in 1572, considered the first “modern” scientific treatise on skin diseases. He discussed AA in much the same way as the ancient Greek transcripts, even outlining treatments for the condition.

The field of dermatology, however, saw very little change in the presentation and treatment of AA for approximately 1500 years. The works of Hippocrates, Celsus, and Galen remained the primary sources of information.

The first “modern” description of AA is attributed to Thomas Bateman (1778-1821) and Robert Willan (1757-1812). Willan pioneered a system for classifying skin diseases based on their appearance rather than symptoms. After Willan’s death, Bateman continued his work and, in 1813, published “A Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr Willan.” Bateman described AA in detail, shedding light on its distinctive patchy characteristics.

The first potential visual representation of AA can be seen in the 1480 painting “Saint Sebastian” by Andrea Mantegna, where the bowman might have alopecia barbae, a variant of AA affecting the beard. The first dermatology atlas to show AA, “the Delineations of Cutaneous Disease,” was published in 1817, featuring a hand-colored engraving of a male with multiple AA patches. In 1868, the first photographic depiction of AA was published, showing a young boy with extensive AA.

In conclusion, alopecia areata (AA) has a long and intricate history, woven into the fabric of ancient medical literature and art. Its early depictions in the Vedas, Ebers Papyrus, and the writings of Hippocrates and Celsus lay the groundwork for our understanding of this condition. As medical knowledge evolved, so too did our interpretation of AA, with the works of Mercuriale, Bateman, and Willan, pushing forward the clinical understanding of the disease.

Moreover, AA’s representation in visual art and medical illustrations provides a compelling testament to its pervasive presence throughout human history. From the potential depiction in Mantegna’s painting to the detailed illustrations in the 19th-century dermatology atlas, these visual records have immortalized the condition, offering a unique perspective that transcends textual descriptions.

The journey of understanding AA has been one of gradual revelation, with each generation adding to our collective knowledge. This journey serves as a reminder that the progression of medical understanding is a continuous process. It underlines the importance of historical knowledge in guiding current and future research efforts in the hope of finding more effective treatments and, ultimately, a cure for conditions like AA.

Bibliography