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What is alopecia areata?

Alopecia areata is a condition that causes hair to fall out in small patches, which can be unnoticeable. These patches may connect, however, and then become noticeable. The condition 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 stress related to hair loss.

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 get worse, 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) 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. There is only evidence that it’s useful for people with limited alopecia areata.
  • 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.

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 bare skin of the affected areas.

The treatment has to be repeated every one to two months to regrow hair. It doesn’t 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 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

Light therapy is also called photochemotherapy or 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:

Most alternative therapies haven’t been tested in clinical trials, so their effectiveness in treating hair loss isn’t known.

Additionally, the Food and Drug Administration (FDA) 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 won’t need treatment because their hair grows back on its own. In other cases, however, people won’t 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 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.

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 the exact cause of this condition.

However, it most often occurs in people who have a family history of other autoimmune conditions, 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 it.

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 health conditions 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 on 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 occurs in both men and women, but the loss of hair is likely to be more significant in men. Men are also more likely to have a family history of the hair loss condition.

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

Females are more likely to develop alopecia areata than males, but it’s not clear why. The hair loss can occur on the scalp, as well as the eyebrows and lashes.

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. In fact, most people with the condition will experience their first hair loss before the age of 30.

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

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

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.

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 this 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 this type of alopecia areata also lose all hair on the face — eyebrows and eyelashes. It’s also possible to lose other body hair, including chest, back, and pubic hair.

Diffuse alopecia areata

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 live with bouts of hair loss and other related symptoms for the rest of your life. Some people, however, may experience hair loss just once.

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

In people with alopecia areata, poor outcomes are 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.

It’s important to keep in mind that more than 5 million people in the United States have alopecia areata. You aren’t 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 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.

Active teens and young adults with completely bald heads 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 hair loss affects the 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 one to three years.
  • YouTube is full of 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 tutorials online 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 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:

Foods with sugar, processed snacks, and alcohol may increase inflammation and irritation within the body.

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 autoimmune response in the body and decrease the chances of another hair loss episode or further hair loss.

To do that, 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.

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.

Alopecia areata can’t be prevented because its cause is unknown.

This autoimmune disorder may be the result of several factors. Those include a family history, other autoimmune condition, and even other skin conditions. But not everyone with any of these factors will develop the hair condition. That’s why preventing it isn’t yet possible.