What Is Alopecia Areata?
Alopecia areata is one type of alopecia, or hair loss. An autoimmune disorder, it causes round or oval bald spots on the scalp and/or other areas of the body that have hair. In many cases, the hair grows back, only to fall out again later. In other cases, the hair will return to normal after just one episode. A small minority of people lose all the hair on their scalp (alopecia totalis) or all the hair on their scalp and body (alopecia universalis).
Patchy hair loss from alopecia areata can happen in people of any age, but it’s most common in children, teens and young adults.
What Causes Alopecia Areata?
Alopecia areata is caused by a malfunction of the immune system. For reasons unknown, in people with this autoimmune hair loss condition, the immune system attacks hair follicles, the holes in the skin through which hair grows. These attacks make the follicles shrink, which slows or stops hair production.
Genes may play a role. People with a first-degree relative who has, or had, a history of alopecia areata are more likely to develop it themselves. But genes don’t tell the whole story. Experts think the condition stems from a combination of a person’s genes and their environment. Pregnancy, extreme stress and trauma may be triggers. Often, however, there’s no obvious trigger.
People with alopecia areata may have a higher risk of eczema, asthma and nasal allergies, as well as other autoimmune diseases such Hashimoto’s thyroiditis and vitiligo. The disorder appears to be slightly more common in African Americans.
Alopecia Areata Symptoms
Alopecia areata usually begins with one or more smooth, round or oval bald patches in the hair. It is most common on the scalp, but it can affect any body hair, including the eyebrows, eyelashes and beard area.
When you lose the hair, it will likely grow back within a year. If it does, it may be white and finer than your other hair, though it should eventually return to your hair’s normal color. If you experience widespread hair loss, the likelihood of the hair growing back is not high, although it has been known to happen.
You may have minor discomfort or itching just before a new bald patch forms. Toenails and fingernails may develop tiny dents or lose their shine and become rough, almost like sandpaper. Rarely, the nails become distorted.
How Is Alopecia Areata Diagnosed?
Making an alopecia areata diagnosis is typically easy. It’s done by examining the scalp, looking at the hair under a microscope and asking questions about the hair loss. A scalp biopsy can confirm the diagnosis if there’s any doubt. A doctor may order a blood test if they’re concerned about the possible existence of another autoimmune disease.
Alopecia Areata Treatment
The body may decide one day to correct the hair loss on its own, but a number of treatment options offer the possibility of faster, more reliable hair regrowth. None are a cure.
Combining treatments may increase their effectiveness. While you’re undergoing treatment, new patches of hair loss may continue to appear.
If you have significant hair loss on your head, consider wearing a wig, hat or scarf to protect yourself from sun and cold. None of these will interfere with hair regrowth.
These anti-inflammatory drugs suppress the immune system. They can be injected or rubbed into the affected areas. Oral corticosteroids may be prescribed for widespread alopecia areata, but they shouldn’t be used long-term due to the potential for serious side effects.
Topical Minoxidil 5% Solution
Prescribed for people of all ages, this treatment could promote hair growth within 12 weeks. It works best when combined with other treatments. Brand names include Rogaine.
Anthralin Cream or Ointment
This tar-like medicine is considered a “scalp sensitizer.” Applied for a specified amount of time and then washed off, it works by deliberately causing skin irritation, which appears to trick the immune system into stopping its attacks on hair follicles. It’s often used together with minoxidil.
Topical Immunotherapy Medications
If the hair loss is widespread, a topical medicine that causes an allergic reaction can help by redirecting the immune system’s attacks on the hair follicles. They include diphencyprone (DPCP), dinitrochlorobenzene (DNCB) and squaric acid dibutyl ester (SADBE). These drugs typically cause a rash and itching.
Immunomodulators increase or decrease the immune system’s response to perceived threats. Some of these oral drugs, including methotrexate, are FDA approved for treating rheumatoid arthritis or another other autoimmune condition, but they are sometimes used off-label to treat alopecia areata.
Recently the FDA has approved two immunomodulators for treating severe alopecia areata. Olumiant (baricitinib), originally developed to treat rheumatoid arthritis, was approved in 2022 to treat adults with severe alopecia areata. Litfulo, approved in 2023, treats severe alopecia areata in people 12 and older. Both drugs are a type of immunomodulator called a JAK inhibitor. In clinical trials, nearly 25% of adults and teens taking Litfulo experienced hair growth that covered 80% or more of their scalp in six months.
Alopecia Areata FAQs
Is Alopecia Areata Contagious?
No. It’s not possible to pass alopecia areata from one person to another.
How Long Does an Episode of Alopecia Areata Last?
It’s anyone’s guess how long an episode will last, as this disorder is highly unpredictable. It often takes months or even years for hair to grow back, if it grows back at all. About half of people with mild alopecia areata recover within a year.
Is Alopecia Areata Permanent?
Damage to the affected hair follicles it not permanent, so the hair may regrow. Some people with alopecia areata have only one episode, but others have recurring episodes. If all hair on the scalp and body is lost, it may not grow back.
How Can I Stop Alopecia Areata from Spreading?
Alopecia areata doesn’t “spread” the way a rash or infection can. New patches form as the immune system attacks other hair follicles. Most treatments encourage hair regrowth but don’t prevent new patches from forming.