What is alopecia areata?

Alopecia areata is a condition that causes your hair to fall out in patches. These patches may connect and then become more noticeable. The condition develops when your immune system attacks the hair follicles causing hair loss.

This kind of hair loss is very common, affecting nearly 7 million people in the United States, according to the National Alopecia Areata Foundation (NAAF). It can affect people of any ethnicity, sex, or age. Alopecia areata may begin in childhood or adulthood. It is also different for each person.

Alopecia areata may occur on your scalp and in some cases, your eyebrows, eyelashes, and face, as well as other parts of your body. It can also develop slowly and recur after years between instances.

When hair loss involves all the hair on your body, the condition is called alopecia universalis. When your hair does grow back, it’s possible you might experience hair loss again. The extent of hair loss and regrowth varies from person to person.

There’s currently no cure for alopecia areata, but there are positive things you can keep in mind about the condition and your outlook.

According to the National Alopecia Areata Foundation, this kind of hair loss does not always become a lifelong condition. The hair follicles themselves are alive, so hair can often be regrown.

There are also treatments that may help your 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 you cope with stress that can be related to hair loss.

The disease burden of alopecia areata is not equal across all populations.

For example, some findings suggest that African American and Hispanic females have a greater lifetime occurrence of the condition when compared with white females. There’s also the suggestion that there’s a lower risk in Asian people compared to white females.

But only a few studies have examined the patterns and determinants of alopecia and pathophysiological factors are largely unexplored.

Further research is required that takes into consideration environmental, behavioral, genetic, and socioeconomic factors as well as access to healthcare.

According to a 2020 study based on an analysis of over 11,000 cases in the National Alopecia Areata Registry between 2000 and 2016, the approximate odds ratios of an alopecia areata diagnosis for various races, with white people as the comparison group, are as follows:

  • 1.77 for African Americans
  • 1.27 for other races, including Native Americans and Pacific Islanders
  • 1 for white people
  • .9 for Hispanic people
  • .4 for Asian people

Based on a 2018 analysis from the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII) of over 1,100 women who reported a diagnosis of alopecia areata, compared with 1.00 odds for white women, the odds for a diagnosis for Black women were 2.72, per the NHS and 5.48, per the NHSII.

For Hispanic women, the odds were 1.94 compared with white women, based on the NHSII. There were no significant incidence differences based on the NHS.

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. It’s also important to remember that treatment isn’t always successful. Some people may continue to have hair loss, even with treatment.

Medical treatments

Topical agents

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) has OTC availability, and while it’s commonly used, it is not FDA approved for alopecia areata. Before applying it to areas such as the scalp, eyebrows, and beard, you should speak with a healthcare professional. There’s only evidence that it’s useful for people with limited alopecia areata. It generally takes about 4–6 months, or longer, to see results.
  • Anthralin (Dritho-Scalp) is a drug that irritates the skin 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 6 months. However, though repeat treatment may be necessary, it isn’t ordinarily done indefinitely.

Injections

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 bald area.

The treatment has to be repeated every 1 to 2 months to regrow hair. It does not prevent new hair loss from occurring.

Oral treatments

Cortisone tablets are sometimes used for extensive alopecia, but due to the possibility of side effects, you should discuss this option 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 cannot 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.

Laser and Light therapy

Light therapy is also called photochemotherapy, which uses a light sensitizer, or phototherapy, which uses specific wavelengths of ultraviolet light for their healing effects. Laser treatment delivers specific doses of radiation to encourage new hair growth. Both therapies are considered safe and effective.

Natural treatment

Some people with alopecia areata choose alternative therapies to treat the condition. However, it’s important to know that these are all experimental. They have not been tested in clinical trials, and there is no solid medical or scientific evidence to show that they’re effective.

Natural and alternative treatments include acupuncture, aromatherapy, vitamins and supplements (including zinc and biotin), essential oils and other oils (such as coconut, tea tree, and castor oil), onion juice rubbed onto the scalp, and probiotics.

There is some evidence that changes to diet may have a positive effect on alopecia areata.

Some individuals with a diagnosed autoimmune condition may consider following an anti-inflammatory diet. This type of eating plan is designed to help reduce the body’s autoimmune response and the chances of another hair loss episode or further hair loss.

On this diet, you eat foods that are known to ease the inflammation process. The foundational foods of this diet, also known as the autoimmune protocol, are fruits and vegetables like blueberries, nuts, seeds, broccoli, beets, and lean meats like wild-caught salmon.

Some studies have also shown that a Mediterranean diet may have a positive effect on alopecia areata.

Eating a balanced diet — one with whole grains, fruits, vegetables, and lean meat — is beneficial to your overall health for many reasons, not just for reducing inflammation.

About Supplements

The Food and Drug Administration (FDA) does not require supplement makers to prove their products are safe. Sometimes the claims on the supplement labels are inaccurate or misleading. Always talk with a healthcare professional before trying any herbal or vitamin supplement.

The effectiveness of each treatment will vary from person to person. Some people won’t need treatment because their hair grows back on its own. However, in other cases, people won’t see improvement despite potentially 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 is an autoimmune condition. An autoimmune condition 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.

However, if you have alopecia areata, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. When the follicles become smaller and stop producing hair, it leads to hair loss.

Researchers don’t know the exact cause of this condition. Some possible risk factors have been identified, including:

  • genetics, such as a close family member with alopecia areata
  • having certain health conditions, such as Down’s Syndrome, thyroid disease, or vitiligo
  • vitamin D deficiency

There is also a condition known as nivolumab-induced alopecia areata. This occurs in people who are being treated with the cancer drug nivolumab. In these cases, hair loss is a sign that the drug is working.

The main symptom of alopecia areata is hair loss. Hair usually falls out in 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 multiple 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 health conditions can also cause hair to fall out in a similar pattern. Hair loss alone is not 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:

Doctors might avoid using the terms “totalis” and “universalis” because some people may experience a degree of hair loss between the two conditions. For example, it’s possible to lose all hair on the arms, legs, and scalp, but not on the chest.

The hair loss associated with alopecia areata is unpredictable, and as far as doctors and researchers can tell, it 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 occurs in both men and women with some sources stating that men are more prone and others saying the opposite.

People may experience hair loss in their facial hair, as well as their scalp, chest, and back hair. Compared with male-pattern baldness, which is a gradual thinning of hair all over, hair loss from this condition causes diffuse and patchy hair loss.

Unlike female-pattern hair loss, which is a gradual thinning of hair that covers a large area, alopecia areata may be confined to a small area. The hair loss may occur all at once, too. The area can gradually expand, which results in greater hair loss.

Children can develop alopecia areata. However typical onset is between 25 and 36 years old.

While there is some hereditary component to alopecia areata, parents with the condition don’t always pass it on to their children. Likewise, children with this type of hair loss may not have a parent who has it.

In addition to hair loss, children may experience nail defects, such as pitting or lesions. Adults may experience this additional symptom, too, but it’s likely more common in children.

According to the NAAF, children younger than 5 years old typically don’t experience much of an emotional impact from alopecia. However, after age 5, hair loss can be traumatizing for young children as they start noticing differences in their hair compared with others.

If your child appears stressed or depressed, ask a pediatrician about supportive resources like recommending a counselor experienced in working with children.

Several types of alopecia areata exist. Each type is characterized by the extent of hair loss and other symptoms you may be experiencing. Each type may also have a slightly different treatment and prognosis.

Alopecia areata (patchy)

The main characteristic of the patchy type of alopecia areata is one or more coin-sized patches of hair loss on the skin or body. If this condition expands, it may become alopecia totalis or alopecia universalis.

Alopecia totalis

Alopecia totalis occurs when you have hair loss across the entire scalp.

Alopecia universalis

In addition to losing hair on the scalp, people with alopecia universalis also lose all hair on the face — eyebrows and eyelashes. Alopecia universalis causes total body hair loss.

Diffuse alopecia areata

Also called alopecia areata incognita, diffuse alopecia areata may look a lot like female- or male-pattern hair loss. It results in sudden and unexpected thinning of hair all over the scalp, not in just one area or patch.

Ophiasis alopecia

Hair loss that follows a band along the sides and lower back of the scalp is called ophiasis alopecia.

The prognosis for alopecia areata is different for each person. It’s also unpredictable.

Once you develop this autoimmune condition, you may experience lifelong bouts of hair loss and other related symptoms. However, some people may only experience hair loss once in their lifetime.

The same variation applies to recovery: Some people may experience full regrowth of hair, while others may not. They may even experience additional hair loss.

For people with alopecia areata, an increased risk of a negative impact on their outlook is associated with several factors:

  • early age of onset
  • extensive hair loss
  • nail changes
  • family history
  • having multiple autoimmune conditions

How to cope with alopecia areata

Alopecia areata can be emotionally challenging, especially when hair loss affects the whole scalp. People with the condition may feel isolated or become depressed. Reaching out for support can be helpful. The National Alopecia Areata Foundation can help connect you with people who understand what you are experiencing.

It’s important to keep in mind that more than 5 million people in the United States have alopecia areata. You are not alone. There are lifestyle changes you can make to help cope with the condition.

If you’re looking for help with wigs, eyelash extensions, or eyebrow stencils, the NAAF 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.

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 hair loss affects your eyebrows, an eyebrow pencil, microblading, and eyebrow tattoos are a few options to consider.

  • Microblading is a semipermanent tattooing technique that fills in the eyebrows using hairlike strokes. It looks more natural than traditional eyebrow tattoos and lasts for 1 to 3 years.
  • YouTube has 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 to, but you can find a few online tutorials on applying eyelash extensions when you don’t have any eyelashes of your own. Here’s one example.

A doctor may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and examining a few hair samples under a microscope.

Your doctor may order a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, the healthcare professional will remove a small piece of skin on your scalp for analysis.

Blood tests might be ordered if the doctor suspects other autoimmune conditions.

The specific blood test performed depends on the particular disorder the doctor suspects.

However, a doctor will likely order tests to check for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it may mean that you have an autoimmune disorder. Depending on findings, additional tests may be ordered to rule out other conditions, such as thyroid problems or hormonal imbalances.

If you’re experiencing hair loss, speak with a doctor to learn more and find out what treatment options are available.