Alopecia areata

Alopecia areata

What is alopecia areata?

Alopecia is a general term for hair loss. Alopecia areata is a common condition of non-scarring (does not cause scarring to the scalp) hair loss that can occur at any age.  

Non-scarring hair loss means that the roots of the hairs have not been permanently lost; therefore, the hair potentially can grow back. It usually causes small, coin-sized, round patches of baldness on the scalp, although hair on other parts of the body, such as the beard, eyebrows, eyelashes, body, can be affected. In some people, larger areas are affected and occasionally it can involve the whole scalp (called alopecia totalis) or the entire body, face, and scalp (called alopecia universalis). Nails can also be seen in some patients. It can affect all genders and occur in both children and adults. 

It is not possible to predict how much hair loss alopecia areata will cause. Hair can regrow on its own   over a period of months, and rarely, over years. However, this cannot be guaranteed and there is a risk of new patches occurring in the future. The chances of the hair regrowing on its own are better, if less hair is lost at the beginning. If more than half the hair is lost, then the chances of a full recovery are low. The hair sometimes regrows white, at least in the first instance. Most people get further episodes of alopecia areata. In alopecia totalis and alopecia universalis, the likelihood of total regrowth is less without treatment.  

A UK based study has demonstrated that alopecia areata patients have higher rates of depression and anxiety than those without alopecia areata which can impact on their daily activities. Therefore, it is important to discuss with your healthcare professional the social or emotional impacts that you might be feeling. They can direct you to the right support – this could mean talking to a therapist, taking medication if needed, or finding support from others who have been through similar experiences. 

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What does it look like?

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Main body location

Face, Head, Scalp


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What causes alopecia areata?

Hair loss in this condition is caused by inflammation of the hair follicle. Studies have shown that our immune system, the natural defence which normally protects the body from infections and other diseases, mistakenly attacks the hair follicle stopping it from growing hair. The exact cause of why this happens is still not fully understood.  

Alopecia areata cannot spread to others and there is no connection to food or diet. There are several theories regarding triggers for alopecia areata including previous infections and stress. However, it is also possible that this link may be coincidental, as it has been impossible to identify such triggers in many people affected by alopecia areata.  

Alopecia areata is an autoimmune condition and has been linked to other conditions such as thyroid disease, vitiligo (white patches in the skin) and type 1 diabetes. It has also been linked to atopic conditions such as eczema, hay fever and asthma. If you experience symptoms other than alopecia areata, please consult your doctor. Your doctor may suggest further tests.  

Is alopecia areata hereditary?

There is a genetic predisposition to alopecia areata. However, not everyone develops hair loss: we know that only in about 20% of people affected by alopecia areata, there is a family history of the condition. It is thought that multiple genetic factors play a role, and it is unclear what triggers the condition. 

What does alopecia areata feel and look like?

Alopecia areata causes sudden hair loss which can affect any parts of the body. There may be itching, burning, or tingling sensation in the affected area before or after the hair loss. If eyelashes are affected, it may cause dry eyes and become sore in dry and windy weather. Some people with alopecia areata develop small pits on their nails or their nails become more brittle and break. 

Typically, alopecia areata starts with one or more bald, smooth patches on the scalp. These patches are not inflamed or scaly. It often affects pigmented hair, so there may be some white hair left within the bald area, especially in older people. Sometimes, instead of distinct patches, the hair loss is spread out.  

In this condition, short, tapered hairs, called exclamation mark hairs may be seen at the edge of the bald patch. Regrowth usually starts at the centre of the bald patch with fine white hairs that thicken with time and usually regain their natural colour.  

Some people with alopecia areata develop small pits on their nails, similar to the dimples seen on a thimble. 

How is alopecia areata diagnosed?

This condition is normally diagnosed following assessment by your doctor. Most patients do not require any tests to confirm the diagnosis. In certain cases, if the diagnosis is uncertain a scalp biopsy may be considered. 

Can alopecia areata be cured? What is the prognosis of this condition?

Currently, there is no cure for this condition.  

Depending on the extent of hair loss there is a good chance that, for 4 out of 5 affected people, complete regrowth will occur within 1 year without treatment. There may, however, be further episodes of hair loss in the future. If there is very extensive hair loss from the start, the chances of it regrowing are not as high. Those with more than half the hair lost at the beginning or with complete hair loss at any stage have only about a 1 in 10 chance of full recovery. The chances of regrowth are lower in the following: 

  • young children,  
  • people with family history of alopecia areata or other autoimmune conditions,  
  • those with hair loss affecting the hairline at the back of the scalp, 
  • those with nail disease.  

What if I need a wig?

Some individuals with alopecia areata may prefer to wear a wig while they wait for recovery. These can either be bought privately or obtained through the NHS on a consultant’s prescription (a financial contribution is usually required in England). Alopecia UK and the British Association of Dermatologists have created a ‘Charter for Best Practice for NHS Wigs Provision’ to help guide patients and health professionals.

Your local hospital orthotic (surgical appliances) department will be able to advise you on the range of hairpieces available on the NHS and can recommend local suppliers who are sensitive to the needs of individuals with alopecia areata. Alopecia UK also provides helpful information on choosing and caring for wigs on their website. 

How can alopecia areata be treated?

People with mild alopecia areata may not require treatment as their hair may regrow on its own. There is currently no cure for this condition and the aim of treatments is to help with symptoms of hair loss. Some treatments can induce hair growth, though none can alter the overall course of the disease.  

The treatments that can be considered depend on the severity of hair loss. This should be discussed with your healthcare professional. 

  • Wigs/ hair pieces and Camouflage/ cosmetics. Wigs/ hair pieces can be a vital treatment for some patients in helping them regain confidence. The availability and provision of wigs are very variable across the UK. Alopecia UK and the British Association of Dermatologists have tried to address this by creating a Charter for Best Practice for NHS Wig Provision. This charter advocates for all patients with alopecia who require a wig to be offered a minimum of x2 acrylic wigs a year.Hair fibres or cosmetics can help camouflage the areas of hair loss. They can be bought online or over the counter. Microblading for eyebrows can help in cases of severe or permanent eyebrow loss. There are also temporary eyebrow transfers available that can be used daily by men and women.  

Topical treatments applied on the skin

Systemic (tablet or injection) treatments

Other treatments

What can I do?

  • Some men and a few women with extensive alopecia find that shaving off the remainder of the hair provides a good solution. 
  • Remember that an important function of hair is to protect the scalp from sunlight. You should cover your bald patches with a sun block or a hat to prevent sunburn and also to reduce the chances of developing long-term sun damage.  
  • The hair also acts as an early warning to prevent scraping the scalp on low doors, cupboards, or trees. Be particularly careful to avoid hurting yourself in these situations. 
  • You can consult your hairdresser about dyeing regrown hair that is slow to regain its colour. 
  • People with long hair may use hair extensions to conceal it. Some hairdressers specialise in this. It is important to avoid putting too much tension on the hair during the process. This is because excessive tension could cause hair loss, called traction alopecia. 

    Images DermNetNZ.

Animation by Stacy Bias, based on real-life interviews conducted by Goldsmiths anthropologist, Emma Tarlo. For further understanding of the social dimensions of hair, see her book, Entanglement: The Secret Lives of Hair. 

This information is provided by the British Association of Dermatologists.

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