Alopecia Areata

What is alopecia areata?

Alopecia areata is a common autoimmune condition that causes hair loss. It usually causes round or oval patches of hair loss on the scalp, but it can affect any hair-bearing area, including the beard, eyebrows, eyelashes and body. The hair follicles are not destroyed, so the hair can grow back.

Who gets it?

Alopecia areata is common, affecting about 2 in 100 people at some point in their life. Anyone can develop it, whatever their age, sex or ethnicity. It most often starts in childhood or young adulthood, but can begin at any age.

What causes it?

In alopecia areata, the immune system attacks the hair follicles, causing them to stop producing hair. The reason this happens is not fully understood. Genetics play a role. Previous infections and stress have been suggested as triggers, but these links may be coincidental.

Is it hereditary or contagious?

About 1 in 5 people with alopecia areata has a family member with it. It is not contagious.

What does it look and feel like?

Alopecia areata typically causes one or more smooth, well-defined patches of hair loss, which often appear quite suddenly. The skin in the patch looks normal, without scarring or scaling, though there may be slight redness. At the margin of a patch there may be short, snapped-off hairs that taper towards the root, called exclamation mark hairs. Some people notice itching, burning or tingling before hair falls out.

In a small number of people, hair loss becomes more extensive. Alopecia totalis means loss of all scalp hair, and alopecia universalis means loss of all body hair. Some people develop a band of hair loss around the sides and back of the scalp, called ophiasis, which tends to be more persistent.

The nails can be affected, with small pits, ridges, roughness or brittleness.

When hair grows back, it is often fine and white or grey at first, and usually regains its normal colour and thickness over time.

Associated conditions

It is seen more often in people who have, or whose relatives have, other autoimmune conditions, including type 1 diabetes, thyroid disease and vitiligo, and in those with eczema, asthma or hay fever.

The emotional impact

Hair loss can be very distressing and can affect self-image, confidence, relationships and mental health. Support is available, and it is important to discuss how the hair loss is affecting you.

How is it diagnosed?

Alopecia areata is usually diagnosed from its appearance, often with the help of a dermatoscope to look closely at the scalp. Tests are not usually needed, although blood tests are sometimes suggested to check for associated conditions such as thyroid disease. A scalp biopsy is occasionally needed if the diagnosis is uncertain.

What are the treatment options?

Dr Mounsey will confirm the diagnosis, examining the scalp with a dermatoscope and arranging blood tests where appropriate. For small patches, options include strong steroid lotions or creams and steroid injections into the patches. For more extensive hair loss, treatments include contact immunotherapy, oral steroids, other immunosuppressant tablets, and JAK inhibitor tablets, which are licensed for severe alopecia areata. He will discuss the likely benefits and risks of each and also signpost support with wigs, eyebrow and eyelash options, and coping with hair loss.

What is the outlook?

The course of alopecia areata is unpredictable. Around 4 in 5 people have complete regrowth within a year without treatment, although further episodes are common. When over half of the scalp hair is lost during the first episode, the chance of complete regrowth falls to around 10 in 100. The outlook is also less favourable when hair loss starts in young childhood, affects the hairline around the edge of the scalp, occurs with nail changes, or when there is a family history.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/alopecia-areata

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.