Alopecia areata is a disease that causes hair to fall out in small patches, which can remain unnoticeable. These patches may eventually connect and then become noticeable, however. This disease develops when the immune system attacks the hair follicles, resulting in hair loss.
Sudden hair loss may occur on the scalp, and in some cases the eyebrows, eyelashes, and face, as well as other parts of the body. It can also develop slowly, and recur after years between instances.
The condition can result in total hair loss, called alopecia universalis, and it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person to person.
There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss, as well as unique ways to cover up the hair loss. Resources are also available to help people cope with the stress of the disease.
The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots.
You may first notice clumps of hair on your pillow or in the shower. If the spots are on the back of your head, someone may bring it to your attention. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata.
In rare cases, some people may experience more extensive hair loss. This is usually an indication of another type of alopecia, such as:
- alopecia totalis, which is the loss of all hair on the scalp
- alopecia universalis, which is the loss of all hair on the entire body
Doctors might avoid using the terms “totalis” and “universalis” because some people may experience something between the two. It’s possible to lose all hair on the arms, legs and scalp, but not the chest, for example.
The hair loss associated with alopecia areata is unpredictable and, as far as doctors and researchers can tell, appears to be spontaneous. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person to person.
Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria.
If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss.
Researchers don’t know what triggers the immune system to attack hair follicles, so the exact cause of this condition isn’t known.
However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata.
They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to the disease.
People with an autoimmune disease, like alopecia areata, are also more prone to having another autoimmune disease, including those that also affect the skin and hair.
If you’ve been diagnosed with alopecia areata and another skin condition, you may find that treating one helps the other. In other cases, however, treating one may make the other worse.
Psoriasis causes a rapid buildup of skin cells. It happens when the immune system mistakenly attacks the skin cells and causes the skin cell production process to go into overdrive. This results in thick patches of skin called plaques, as well as red, inflamed areas of skin.
Treating psoriasis with alopecia can be tricky. The scaling associated with psoriasis can make the skin itchy, and scratching can make hair loss worse. In addition, biologic treatments often used for psoriasis, called TNF inhibiters, have been associated with hair loss in some people.
For others, treating the psoriasis may help regrow hair. In one small study, over two-thirds of participants with alopecia areata who took a common psoriasis treatment called methotrexate had hair regrowth greater than 50 percent.
Atopic dermatitis (eczema)
Researchers have established a link between alopecia and atopic dermatitis, a condition in which inflammation on the skin causes itchy, red rashes. Atopic dermatitis is more commonly known as eczema.
Many treatment options for atopic dermatitis, like steroid creams and phototherapy, overlap with alopecia treatments, so it’s possible that treating one condition will help treat the other.
One area of interest for treating both atopic dermatitis and alopecia is a class of drugs called JAK inhibitors. They’re currently used to treat rheumatoid arthritis and other conditions. One oral JAK inhibitor known as tofacinitib has already shown promise in small clinical trials for both atopic dermatitis and alopecia areata.
Another biologic treatment called dupilumab (Dupixent), which has recently been approved by the FDA to treat atopic dermatitis, is also a drug of interest for treating alopecia. A clinical study evaluating dupliumab in people with alopecia — both with and without atopic dermatitis — is currently underway.
A doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope.
Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis.
Blood tests might be done if other autoimmune conditions are suspected.
The specific blood test performed depends on the particular disorder the doctor suspects. However, a doctor will likely test for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it usually means that you have an autoimmune disorder.
Other blood tests that can help rule out other conditions include the following:
- C-reactive protein and erythrocyte sedimentation rate
- iron levels
- antinuclear antibody test
- thyroid hormones
- free and total testosterone
- follicle stimulating and luteinizing hormone
There’s no known cure for alopecia areata, but there are treatments that you can try that might be able to slow down future hair loss or help hair grow back more quickly.
The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. For some people, hair loss may still worsen despite treatment.
You can rub medications into your scalp to help stimulate hair growth. A number of medications are available, both over-the-counter (OTC) and by prescription:
- Minoxidil (Rogaine) is available OTC and applied twice daily to the scalp, eyebrows, and beard. It’s relatively safe, but it can take a year to see results.
- Anthralin (Dritho-Scalp) is a drug that irritates the skin in order to spur hair regrowth.
- Corticosteroid creams such as clobetasol (Impoyz), foams, lotions, and ointments are thought to work by decreasing inflammation in the hair follicle.
- Topical immunotherapy is a technique in which a chemical like diphencyprone is applied to the skin to spark an allergic rash. The rash, which resembles poison oak, may induce new hair growth within six months, but you’ll have to continue the treatment to maintain the regrowth.
Steroid injections are a common option for mild, patchy alopecia to help hair grow back on bald spots. Tiny needles inject the steroid into the bare skin of the affected areas.
The treatment has to be repeated once every one to two months to regrow hair. It doesn’t prevent new hair loss from occurring.
Cortisone tablets are sometimes used for extensive alopecia, but due to the possibility of side effects, this option should be discussed with a doctor.
Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma.
Light therapy is also called photochemotherapy or just phototherapy. It’s a type of radiation treatment that uses a combination of an oral medication called psoralens and UV light.
Some people with alopecia areata choose alternative therapies to treat the condition. These may include:
- low-level laser therapy (LLLT)
- vitamins, like zinc and biotin
- aloe vera drinks and topical gels
- onion juice rubbed onto the scalp
- essential oils like tea tree, rosemary, lavender, and peppermint
- other oils, like coconut, castor, olive, and jojoba
- an “anti-inflammatory” diet, also called the “autoimmune protocol,” which is a restrictive diet that mainly includes meats and vegetables
- scalp massage
- herbal supplements, such as ginseng, green tea, Chinese hibiscus, and saw palmetto
Most alternative therapies haven’t been tested in clinical trials, so their effectiveness in treating hair loss isn’t known.
Additionally, the U.S. Food and Drug Administration doesn’t require supplement makers to prove their products are safe. Sometimes the claims on the supplement labels are inaccurate or misleading. Always talk to a doctor before trying any herbal or vitamin supplement.
The effectiveness of each treatment will vary from person to person. Some people don’t even need treatment since their hair grows back on its own. In other cases, however, people never see improvement despite trying every treatment option.
You might need to try more than one treatment to see a difference. Keep in mind that hair regrowth may only be temporary. It’s possible for the hair to grow back and then fall out again.
Alopecia areata can be emotionally challenging, especially when hair loss affects the whole scalp. People with the condition may feel isolated or become depressed.
It’s important to keep in mind that more than 5 million people in the United States have alopecia areata. You aren’t alone. Depending on your age, there are lifestyle changes you can make to help cope with the condition:
According to the National Alopecia Areata Foundation, children younger than age 5 typically don’t experience much of an emotional impact from alopecia. After age 5, however, hair loss can be traumatizing for young children as they start noticing how they’re different from others.
If your child appears stressed or depressed, ask a pediatrician to recommend a counselor experienced with children.
If possible, try to find a hairstylist in your area who is used to working with children who have lost their hair. Nonprofits like Locks of Love and Wigs for Kids can provide low-cost or free wigs for your child.
Parents should make sure that their child wears sunscreen to protect the exposed areas of skin and sunglasses to protect the eyes if the eyelashes have fallen out.
Young adults are already vulnerable to bullying and teasing as it is. Hair loss can make it much worse. Kids with alopecia may live with the fear that a classmate will pull off their wig or hat.
Bullying can happen at school or online. Make sure to talk to your child’s school staff so they can intervene on behalf of your child, and to monitor your child’s online behaviors.
The unpredictability of the condition can be an emotional roller coaster for teens and young adults. Hair can come and go in an erratic fashion. When hair starts to grow back, it can cause false hope for recovery. It’s important to seek counseling for young adults to deal with body image and self-confidence issues at a young age.
If you’re looking for help with wigs, eyelash extensions, or eyebrow stencils, the National Alopecia Areata Foundation maintains an online shop with hair accessories and products. Wig companies like Godiva’s Secret Wigs also have online videos and tutorials for help with styling and care.
For active teens and young adults with completely bald heads, you can attach suction cups to wigs and hair pieces so the wig won’t fall off while playing sports.
New wig technologies, like the vacuum wig, which is made from silicon and a suction base, mean that people with alopecia can even swim with their wigs still in place. Vacuum wigs, however, are typically more expensive.
If you’re feeling overwhelmed, counselors or support groups can help you cope with the effects of the disease. You may also find others with the disease in an online community, like Alopecia World, for people with alopecia and similar conditions.
Non-uniform loss of hair makes it difficult to maintain a positive image in public.
You can cover up bald patches with a hat or stylish scarf, but this solution won’t work all the time. You may feel pressured to remove the hat or scarf during the singing of the National Anthem or at your place of employment.
Some nightclubs also have a dress code that discourages wearing hats.
Wearing scarves can create problems with airport security. Most TSA agents will trust you if you say that you’re covering your head due to a medical condition, and offer to test your head covering for security instead. It may be a good idea to travel with a doctor’s note to be safe, or if you are travelling internationally.
Wigs and hairpieces have come a long way over the years. Though they can be expensive, hair extensions and coverups, such as those offered by Hidden Crown, are designed to blend in with just about any hair color and type.
Another option, though more extreme, is to remove the remaining hair through shaving or laser hair removal. being totally bald may be less noticeable than having multiple bald spots. Some people even find that shaving their heads is quite liberating. It can also minimize the depression of watching hair slowly fall off.
If hair loss affects the eyebrows, an eyebrow pencil, microblading, and eyebrow tattoos are a few options to consider.
- Microblading is a semi-permanent tattooing technique that fills in the eyebrows using hairlike strokes. It looks more natural than traditional eyebrow tattoos and lasts for one to three years.
- YouTube abounds with makeup tutorials on how to fill in and style your eyebrows. Both women and men who lose their eyebrows can practice filling them in with real-life video tutorials, like this one.
- Eyelash extensions are difficult to apply when you don’t have a surface for them to adhere, but you can find a few tutorials online on applying eyelash extensions when you don’t have any eyelashes of your own. Here’s one example.
Hair loss can make dating and social experiences more difficult for adults. With that said, a good partner should be understanding of the condition and be a source of support.