Medical & Surgical Dermatology

Alopecia Areata

Losing your hair can be a challenging situation, especially when you don’t know what’s causing it. There’s a dermatology condition called alopecia areata (AA) that may be behind the mystery. Alopecia literally means hair loss. When you have this condition, you lose hair in round patches resulting in bald spots. A small minority of individuals with this noncontagious condition will lose all of their hair on their scalp or on their body. In many cases, the hair grows back only to fall out again. Hair loss can also last many years. In other cases, the patient’s hair will return to normal after just one episode. At Water’s Edge Dermatology, we’ve treated patients at all ends of the spectrum.

Alopecia areata is not a condition that is caused by stress. The culprit is the immune system. For reasons unknown, it attacks the hair follicles, which causes hair loss. Having this condition is not a sign of a life-threatening disease, and most people who have it are otherwise healthy. Persons with AA may have a higher risk of atopic eczema, asthma, and nasal allergies, as well as other autoimmune diseases such as thyroid disease (Hashimoto’s thyroiditis), and vitiligo.

Four million Americans will develop alopecia areata in their lifetime, which is around 2% of the population. Children and young adults are the most stricken group, but it can develop at any age. When you lose the hair, chances are it will grow back within a year, but it may be white and finer than your existing hair. If you do experience widespread loss, the chances of the hair returning are not very high, although it has been known to happen. This is a very mysterious and unpredictable dermatological condition.

The only obvious symptom of AA is hair loss, but it can be accompanied by itching or minor discomfort just before a new patch is formed. Toenails and fingernails may indicate a problem by showing small dents that are the size of a pinpoint, or by losing their shine and becoming rough, almost like sandpaper.

Most cases of AA are easily identified by examining the scalp and asking questions about hair loss, but if your Water’s Edge Dermatology practitioner is still unsure, they will perform a scalp biopsy. They may also ask for a blood test if they’re concerned about the existence of another autoimmune disease.

Alopecia areata can be a frustrating condition because the extent and consistency of the disease varies from person to person. While there is no cure, the body may decide one day to autocorrect the problem, thereby putting the brakes on hair loss. But for those who are not so fortunate, there are treatment options that could result in faster, more reliable hair regrowth. That’s why it’s important to see your Water’s Edge Dermatology practitioner to find the correct course of action for your case.

There are several treatment options available. They are:

•  Corticosteroids – These anti-inflammatory drugs suppress the immune system. They can be injected or rubbed into the affected areas, or given as pills, but the oral solution is the road less taken.

•  Topical minoxidil 5% solution – Prescribed for people of all ages, this could promote hair grow within 12 weeks.

•  Anthralin – This is a form of short contact therapy, meaning it’s applied for a specified amount of time (no more than 60 minutes) then washed off.

•  Other alternatives – Important options to consider for people who have experienced widespread hair loss are wigs, hats and scarves. None of these interfere with hair regrowth.

Water’s Edge Dermatology wants to find solutions for all patients with alopecia areata because we know how difficult it can be emotionally to deal with hair loss.

Alopecia areata (AA) causes hair loss in small, round patches that may go away on their own, or may last for many years. Nearly 2% of the U.S. population (about four million people) will develop AA in their lifetime. Some people with AA (about 5%) may lose all scalp hair (alopecia totalis) or all scalp and body hair (alopecia universalis). The immune system, for unknown reasons, attacks the hair root and causes hair loss.

Who gets AA?

AA occurs world-wide in both genders and in every ethnic group. Children and young adults are most frequently affected, but persons of all ages are susceptible. One in five persons with AA has a family member who also has the disease.

What are the signs and symptoms of AA?

AA usually begins with one or more small, round, coin-size, bare patches. It is most common on the scalp, but can involve any hair-bearing site including eyebrows, eyelashes, and beards. Hair may fall out and regrow with the possibility of full hair regrowth always present. AA usually has no associated symptoms, but there may be minor discomfort or itching prior to developing a new patch. Nails may have tiny pinpoint dents and may rarely become distorted.

What causes AA?

AA is not contagious. It is an autoimmune disease in which the body's immune system attacks itself, in this case, the hair follicles. The cause is not known. A person's particular genetic makeup combined with other factors triggers AA.

What tests are done to confirm AA?

Although your dermatologist may know by examining your scalp that you have AA, occasionally, a scalp biopsy is helpful in confirming the diagnosis.

Is this a symptom of a serious disease?

AA is not a symptom of a serious disease and usually occurs in otherwise healthy individuals. Persons with AA may have a higher risk of atopic eczema, asthma, and nasal allergies, as well as other autoimmune diseases such as thyroid disease (Hashimoto's thyroiditis), and vitiligo. Family members may also have atopic eczema, asthma, nasal allergies, or autoimmune diseases (i.e. insulin-dependent diabetes, rheumatoid arthritis, thyroid disease, or systemic lupus erythematosus).

Will the hair grow back?

Yes, it is likely that the hair may regrow, but it may fall out again. The course of the disease varies from person to person, and no one can predict when the hair might regrow or fall out again. This unpredictability of AA, and the lack of control over it, makes this condition frustrating. Some people lose a few patches of hair, the hair regrows, and the condition never returns. Other people continue to lose and regrow hair for many years. The potential for full regrowth is always there, even in people who lose all the hair on their scalp and body (alopecia totalis/universalis). Hair could regrow white or fine, but the original hair color and texture may return later.

What treatments are available?

There is no cure for AA. While treatments may promote hair growth, new patches of hair loss may continue to appear. The treatments are not a cure. Only the body, itself, can eventually turn off the condition.


  are anti-inflammatory drugs that suppress the immune system. They can be given as injections into the areas of hair loss, taken as pills, or rubbed into affected areas. Steroid injections every 3-6 weeks are given directly into hairless patches on the scalp, eyebrow, and beard areas. Hair growth usually begins approximately 4 weeks after the injection. Steroids that are rubbed directly into affected areas are less effective than injections. Corticosteroids taken by mouth have potential side effects. They are not used routinely, but may be used in certain circumstances.

Topical minoxidil 5% solution

may promote hair growth in alopecia areata. Minoxidil 5% solution applied twice daily to the scalp, brow, and beard areas may promote hair growth in both adults and children with AA. New hair growth may appear in about 12 weeks.


is a synthetic tar-like substance that alters immune function in the affected skin. It is applied for 20 to 60 minutes ("short contact therapy") and then washed off to avoid skin irritation. Irritation is not needed in order to stimulate hair regrowth in AA.

Combinations of these treatments may add to the effectiveness. Hopefully, new hair growth will appear in 8 to 12 weeks.

Other Alternatives

Wigs, caps, hats, or scarves are important options. Wearing a head covering does not interfere with hair regrowth. This may be a good choice for people with extensive scalp hair loss who do not have enough hair to cover it.

Will alopecia areata affect life?

The emotional aspects of living with hair loss can be challenging, especially in a society that regards hair as a sign of youth and good health. It is reassuring that alopecia areata does not affect general health, and should not interfere with your ability to achieve all of your life goals at school, in sports, in your career, and in raising a family.

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