An Overview of Alopecia Areata

Alopecia Areata causing bald patches on a man's chin

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In This Article

Alopecia areata is an autoimmune disorder characterized by the rapid onset of hair loss in a sharply defined area. The term alopecia areata literally means "patchy baldness," and any hair-bearing skin can be affected (even eyebrows and eyelashes), with the most noticeable being the scalp and face.

The condition is non-scarring and while it attacks hair follicles, it doesn't destroy them, so hair will re-grow over time. Children, teens and adults can be affected and genetics play a part in who develops it. Even though alopecia areata usually resolves itself, some treatment options exist, as well as coping strategies when hair loss causes anxiety and embarrassment.

Symptoms

People who have this condition are, for the most part, otherwise healthy. Alopecia areata is not a sign or symptom of a more serious or underlying condition.

The most common symptoms of alopecia areata include:

  • Round or oval patches of baldness on hair-bearing areas.
  • Possible burning or tingling in the area, though this isn't always the case.
  • Healthy-looking skin where the hair loss occurred, with no signs of rash or irritation.
  • Rapid hair loss, sometimes within just a few days.
  • Hair regrowth in one area while falling out in another.

"Exclamation-mark" hairs may be seen at the margin of the patch. These are broken, short hairs that taper at the base. Pulling slightly on these hairs causes them to fall out.

Note: Some cases may cause widespread hair loss including total baldness (alopecia totalis) and loss of all body hair (alopecia universalis).

Up to 20% of people with the condition also develop finger- or toenail symptoms:

  • Softer or brittle nails
  • Dents or ridges across the nail
  • Nails that feel rough or "sandpaper-like"
  • Red coloration of the nail bed

Causes

Alopecia areata is an autoimmune disorder, which means the body's own immune system, for unknown reasons, attacks the hair follicles causing hair loss.

When the immune system perceives a threat from an outside intruder (bacteria, for example), the body responds by sending inflammatory substances to the affected area. In this case, even though a threat doesn't exist, the body creates antibodies to its own hair follicle structures.

The "life" of a hair has three phases: anagen (growth), catagen (maturity), and telogen (death, or falling out). Normally, all of our hairs go through these stages at random and the growing hairs on the rest of the head outnumber the hairs that fall out.

Alopecia areata's inflammatory immune response triggers a premature telogen or late catagen stage within the hair follicles.

Risk Factors

Alopecia areata is fairly common, with up to 2% of the population experiencing it at some point.

The condition can occur at any age. However, the vast majority of cases develop before age 30. It's also quite common in children and teenagers. Early-onset alopecia areata, occurring between ages 5 and 10, tends to be most severe.

Certain factors make a person more likely to develop the condition:

  • Genetic predisposition. Approximately 18% of people with alopecia areata have a close relative with the condition.
  • Atopic conditions. Atopic dermatitis (eczema), allergies, and/or asthma may raise your risk.
  • Autoimmune diseases. Thyroid conditions, lupus, psoriasis, rheumatoid arthritis, or vitiligo may contribute.
  • Race. A 2018 analysis found alopecia areata to be more common in those who are black or Hispanic, at least for women. More research is needed to see if that holds true for both sexes.
  • Cold weather. Low temperatures don't cause alopecia areata, though wintry weather can be a trigger among those who already have the condition. A 2018 study in the Journal of the American Academy of Dermatology showed some hair loss flares happening more often during the winter months with periods of regrowth during the summer.

Diagnosis

No specific test exists to diagnose alopecia areata. In most cases, your physician should be able to diagnose alopecia areata by a physical exam of your hair and nails, taking a detailed medical history into account.

Your doctor may also do some blood tests to look for autoimmune diseases and to rule out other diseases that may mimic alopecia areata, such as:

  • Telogen effluvium. Generalized hair loss caused by pregnancy, certain drugs, high fever, or stress.
  • Androgenic alopecia. Also known as male-pattern baldness.
  • Trichotillomania. Manually pulling the hair out caused by a psychological disorder.
  • Secondary syphilis. A "moth-eaten" baldness pattern over the entire scalp.

Treatment

Alopecia areata can't be cured. However, in the majority of patients, the hair will regrow completely within one year without any treatment.

That said, because hair loss can be embarrassing and cause anxiety, the condition can be treated. It's important to note that treatment isn't always necessary or advisable. The decision to treat alopecia areata depends on many factors, including the age of the person affected, the severity of the hair loss, and where the hair loss is occurring.

The most common course of action is simple observation. If the patch of hair loss is small, it is reasonable to observe it and allow the hair to regrow on its own.

Topical steroids. This is a first-line treatment choice for both children and adults. Applying a strong topical steroid such as Diprolene (betamethasone) or Temovate (clobetasol) to the patch may stimulate hair regrowth. It may take several months for the hair to grow back using this method.

Steroid injection. This is considered the treatment of choice for adults with alopecia areata of the scalp and eyebrows. Your doctor will inject a steroid such as triamcinolone acetonide or Celestone (betamethasone) into the affected skin.

Initial regrowth of hair can be seen in four to eight weeks, with treatments being repeated every four to six weeks. The main side effect of any steroid use is thinning of the skin. These injections are not used in children younger than 10 years old.

Rogaine or Theroxidil (generic minoxidil). The hair growth drug has shown cosmetically acceptable results in 30% of cases. This medication is applied topically to the affected areas and comes in either a foam or a solution.

Minoxidil does not stop the disease process, so stopping applications after hair has started to grow back may cause the hair to fall out again.

Due to relative safety, this is also a good treatment choice for young children.

Topical contact sensitizers. This type of treatment is designed to produce a contact dermatitis, or irritation, at the site in order to stimulate hair growth. The most common irritant used is called anthralin.

Oral Steroids. Medications such as prednisone are not used as first-line treatment but they may be prescribed in severe cases of widespread hair loss, as in the case of alopecia totalis or universalis.

Taking a short course of oral steroids for about six weeks can regrow hair. Because of the risk of side effects, oral steroids should not be taken long term. Also, once oral steroids are stopped the new hair may fall out again.

After oral steroids are stopped most people are switched over to another treatment to continue hair regrowth.

JAK inhibitors. These drugs, designed to blunt inflammation by blocking signaling pathways during the immune response, are not yet used extensively but have shown short-term promise treating alopecia areata. Depending on the study cited, between 50% to 91% of people showed significant improvement.

Tofacitinib, ruxolitinib, and baricitinib are among the JAK inhibitors currently being studied for their use in treating alopecia areata.

Important note: This treatment is in the early stages. More research is needed. No studies exist examining the long-term safety of using JAK inhibitors for alopecia areata. Also, the most appropriate or effective dosage has not yet been determined.

Coping

The sudden and unpredictable nature of this type of hair loss can be difficult to cope with. This is especially true when the condition appears during the formative childhood and teen years.

Both children and adults can experience a loss of self-esteem or social withdrawal due to this condition. Watch for signs of depression or anxiety; they should be reported to a doctor.

Wigs and hair pieces. Some people may wish to consider wigs, hairpieces, or hair prostheses. There is a vast array of options available, so there will most likely be a product that works for you or your child's needs.

False lashes. For eyelash loss, temporary lashes can be applied with washable adhesive. Semi-permanent lashes last up to eight weeks. These can be applied by trained hairdressers and estheticians and done at your local salon.

Care must be used when removing any false lashes. Never pull on false lashes to remove them so that you don't inadvertently pull out existing lashes or lashes that are trying to regrow.

Support groups. Connecting with those who have similar conditions can be very rewarding. The National Alopecia Areata Foundation can help connect you to local support groups and also offers phone support by peer mentors.

A Word From Verywell

Alopecia areata is a challenging condition. In many people, the condition resolves spontaneously with complete hair growth, but they must deal with rapid and noticeable hair loss in the meantime. Talk to your doctor not just about potential treatments, but cosmetic options to reduce embarrassment and anxiety.

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Article Sources

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