What is alopecia areata?
Alopecia areata is an acquired skin disease that can affect all hair-bearing skin and is characterized by localized areas of non-scarring hair loss. Alopecia areata is occasionally associated with any other external or internal medical problems. Most often these bald areas regrow their hair spontaneously.
How common is alopecia areata?
Alopecia areata is common. The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30. Women and men are affected equally. Please discuss with your doctor for further information.
What are the symptoms of alopecia areata?
The common symptoms of alopecia areata are:
- Patchy hair loss: The problem often begins with 1 or more coin-sized, round, smooth, bare patches where hair once was. You may first notice the problem when you see clumps of hair on your pillow or in the shower. Hair loss occurs mostly on the scalp. But it can involve eyebrows, eyelashes, beards — any hair-bearing site. Patches vary in size.
- “Exclamation mark” hairs: Often, a few short hairs occur in or at the edges of the bare spots. These hairs get narrower at the bottom, like an exclamation mark.
- Widespread hair loss: With time, some patients go bald. Some lose all their body hair, too. This is not common. Also uncommon is a band of hair loss at the back of the scalp.
- Nail problems: Alopecia areata also can affect your fingernails and toenails. Nails can have tiny pinpoint dents (pitting). They also can have white spots or lines, be rough, lose their shine, or become thin and split. Rarely nails change shape or fall off. Sometimes nail changes are the first sign of alopecia areata.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes alopecia areata?
Current evidence suggests that alopecia areata is caused by an abnormality in the immune system. This particular abnormality leads to autoimmunity, a misguided immune system that tends to attack its own body. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, the body’s own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune lymphocytes penetrating into the hair bulb of the hair follicles. Alopecia areata is occasionally associated with other autoimmune conditions such as thyroid disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative colitis. The diagnosis or treatment of these diseases is unlikely to affect the course of alopecia areata. Sometimes, alopecia areata occurs within family members, suggesting a role of genes.
What increases my risk for alopecia areata?
There are many risk factors for alopecia areata, such as:
- A family history of the condition.
- Having the condition at a young age (before puberty) or for longer than 1 year.
- A personal history of another autoimmune disease.
- Allergies (atopy).
- Extensive hair loss.
- Abnormal color, shape, texture, or thickness of the fingernails or toenails.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is alopecia areata diagnosed?
Alopecia areata is diagnosed through a medical history and physical examination. Your doctor will ask you questions about your hair loss, look at the pattern of your hair loss, and examine your scalp. And he or she may tug gently on a few hairs or pull some out.
If the reason for your hair loss is not clear, your doctor may do tests to check for a disease that could be causing your hair loss. Tests include:
- Hair analysis. Your doctor will take a sample of your hair and examine it under a microscope. A scalp sample is also sometimes taken.
- Blood tests, including testing for a specific condition, such as an overactive or underactive thyroid gland (hyperthyroidism or hypothyroidism).
How is alopecia areata treated?
Because hair usually grows back within a year, you may decide not to treat alopecia areata.
If you choose not to treat the condition and wait for your hair to grow back, you may wish to:
- Wear hairpieces. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. But hair weaving, which involves sewing or braiding pieces of longer hair into existing hair, is not recommended because it may cause permanent hair loss.
- Use certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. But continual use of perms or dyes may result in more hair loss.
The most common treatment for patchy hair loss is many injections of corticosteroids into the scalp or skin, about 1 cm (0.4 in.) apart, every 4 to 6 weeks.
Children and some adults may be treated with topical corticosteroids that are applied to the affected skin.
Minoxidil (Rogaine) may be used along with topical corticosteroids.
Anthralin is an ointment that may help hair grow again. It looks and feels like tar, and it can irritate and stain the skin. So anthralin is applied to bare patches on the scalp only for a short time and then is washed off. It may take 2 months or more for new hair to grow.
Contact immunotherapy triggers an allergic reaction on the scalp that may help hair to grow. A medicine is “painted” on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of beginning treatment. Side effects of contact immunotherapy include a severe rash (contact dermatitis) and swollen lymph nodes, especially in the neck.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage alopecia areata?
The following lifestyles and home remedies might help you cope with alopecia areata:
As conventional treatments for alopecia are extremely limited, studies that support natural treatments for alopecia are even thinner on the ground.
There are some people that recommend rubbing onion or garlic juice, cooled green tea, almond oil, rosemary oil, honey, or coconut milk into the scalp. While none of these are likely to cause harm, their effectiveness is also not supported by research.
Some people turn to alternative treatment methods such as acupuncture and aromatherapy, although there is little, if any, evidence to support these treatments.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: January 3, 2018 | Last Modified: January 3, 2018
What's to know about alopecia areata? https://www.medicalnewstoday.com/articles/70956.php. Accessed January 2, 2017.
Alopecia Areata. https://www.medicinenet.com/alopecia_areata/article.htm. Accessed January 2, 2017.
Alopecia Areata - Topic Overview. https://www.webmd.com/skin-problems-and-treatments/hair-loss/tc/alopecia-areata-topic-overview#1. Accessed January 2, 2017.
ALOPECIA AREATA: SIGNS AND SYMPTOMS. https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata#symptoms. Accessed January 2, 2017.