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Alopecia Areata: Causes, Symptoms, and Treatments

Knox Beasley, MD

Reviewed by Knox Beasley, MD

Written by Grace Gallagher

Published 03/30/2021

Updated 04/14/2024

If you find yourself thinking about thinning hair (as one does), you probably picture a bald spot or a receding hairline — but as with alopecia areata, hair loss comes in many forms. This condition causes quarter-sized patchy hair loss all over the head.

If you’re seeing patches of hair loss around your scalp or face, you’re most likely dealing with alopecia areata. But what is alopecia areata, exactly? Well, you’re in the right place to find out.

Below, we’ll discuss what this condition is, what causes alopecia areata and what symptoms to look out for. And because we wouldn’t gate-keep, we’ll also go over treatment options for alopecia areata.

For the linguists among us, alopecia is the medical term for any type of baldness, and areata means it occurs in small, random areas.

Alopecia areata is an autoimmune disease that causes patchy hair loss. It develops when your immune system targets and attacks your hair follicles.

Alopecia areata’s exact pathogenesis (how it develops and progresses) isn’t known. But research suggests that both genetic and environmental risk factors (things like stress, infections or smoking) play a part.

How Autoimmune Conditions Affect Hair

Here’s a quick analogy on how autoimmune diseases work: If your body were a building, imagine your immune system as the security team, keeping out harmful invaders.

But in the case of an autoimmune disorder, that team gets a bit overzealous and starts to misidentify harmless (or even beneficial) occupants (like your hair follicles) as threats. Instead of protecting the building, the security team ends up damaging its own infrastructure. No good.

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About 700,000 people in the U.S. currently have a form of alopecia areata, and about two percent of the global population will experience it at some point in their lives.

But it’s not as common as male pattern baldness, which affects up to 50 percent of men by age 50.

Unlike male pattern baldness (also called androgenetic alopecia), which is more likely to develop with age, alopecia areata is actually more common in younger folks. Over 80 percent of people with the disease show signs of hair loss before they turn 40, and 40 percent experience symptoms by age 20.

No. Like other autoimmune diseases, alopecia areata isn’t contagious. The condition can’t be passed through skin contact, bodily fluids or airborne particles.

Unfortunately, no. Alopecia areata won’t go away. Medications and other types of treatment can help manage the condition and the hair loss it causes, but there’s no cure for alopecia areata.

Alopecia areata is a type of autoimmune hair loss that can make you lose small patches of hair on your scalp or face. These patches are typically circular or oval and about the size of a quarter, but it can vary.

Alopecia areata is caused by the immune system, whereas androgenic alopecia happens when the male sex hormone dihydrotestosterone (DHT) damages hair follicles. Then there’s telogen effluvium, a type of temporary hair loss that can develop due to stress, infections or nutritional deficiencies.

More specifically, your immune system (remember the security team?) can mistakenly identify harmless cells as dangerous and attack them. This damage can cause your hair to shed.

Alopecia Areata Risk Factors

As we touched on earlier, the exact cause of alopecia areata isn’t known (and there may not be just one singular cause). However, various genetic and environmental risk factors may play a role.

These factors for alopecia areata include:

  • Other autoimmune diseases and allergic conditions. Alopecia areata is more common among people with other autoimmune conditions like thyroid disease, vitiligo and psoriasis, as well as allergies such as hay fever.

  • Genetic risk factors. Several genes may play a role in the development of alopecia areata. If you have a family member affected by the disease, you might have an increased risk for this form of hair loss.

  • Emotional stress. High levels of emotional stress might be a contributing factor for alopecia areata. But lots of folks develop this type of hair loss without any psychological triggers.

  • Infections. Some researchers believe alopecia areata can be triggered, at least in part, by specific viral infections like Epstein-Barr virus (EBV) and cytomegalovirus (CMV).

With alopecia areata, inflammatory cells wrongly target and attack hair follicles in the anagen (growth) phase of the hair growth cycle. This is when hair follicles produce new hairs that gradually grow to their full length.

The attack can push your hair follicles into the next stage of the natural hair growth cycle (the catagen phase) early.

After that, your hair follicles enter the telogen phase. This is the resting stage when active hair growth stops. During the telogen phase, the club hair — a hair strand with a firm, club-shaped base, like an exclamation point — sheds from your scalp.

By attacking hair follicles throughout this process, your immune system can weaken the hair shaft — the visible part of your hair that grows out from your scalp. This can cause your hair to break, leaving you with visible bald patches, thin hair and little hair growth.

Alopecia areata can vary significantly in type and severity. Some forms of alopecia areata can cause random bald spots on your head, while others lead to severe hair loss that may affect the entire scalp.

There are three main types of alopecia areata:

  • Alopecia areata. Also called “patchy alopecia areata,” is the most common form. It involves hair loss in one or more coin-sized patches on the scalp, face or other areas of the body.

  • Alopecia totalis. This type of alopecia areata causes total or near-total hair loss across the entire scalp. You may notice that your hair looks extremely thin and falls out en masse, leaving you with little to no hair on your head.

  • Alopecia universalis. This type of alopecia areata causes total or near-total hair loss on the scalp, face and anywhere you’d normally have body hair. Alopecia universalis is less common than other types of alopecia areata.

There are also several subtypes of alopecia areata. One is ophiasis, where hairs shed in a band-like pattern around the back and sides of the scalp. Then there’s sisaipho, in which most hair loss occurs around the outermost part of your head.

Another subtype of alopecia areata is canities subita — or Marie Antoinette syndrome. It can involve diffuse hair loss coupled with sudden graying or whitening of your hair (hence the nickname Marie Antoinette).

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You probably have a pretty good idea of what the symptoms of alopecia areata look like, but some may surprise you.

Alopecia areata symptoms include:

  • Small round or oval-shaped patches of hair loss on the scalp

  • Patchy hair loss and broken hairs in the eyebrows, eyelashes or facial hair

  • Areas with significant hair loss on the body, such as the abdomen or limbs

  • Complete loss of hair once small patches of hair loss form into large hairless areas

  • Changes in fingernails and toenails, including ridges and pits

If you’re experiencing any of these signs of alopecia areata, get in touch with your healthcare provider.

Most of the time, hair loss from alopecia areata eventually grows back. So typically, hair loss isn’t permanent.

However, you might be more likely to experience regrowth if you have mild alopecia, develop it relatively late in life, don’t experience any nail changes or have no family history of hair loss.

To diagnose alopecia areata, a dermatology specialist or another healthcare provider will typically look at your hair and nails, ask questions about your family and medical history and examine your hair follicles with a magnifying glass.

Medical professionals may also do a hair-pull test. This involves (gently) tugging a handful of hairs at the base of your scalp to see if more than 10 percent of the strands come out, which would be a sign you’re experiencing more than just normal shedding.

In some cases, your provider may want to perform a blood test to rule out other causes of hair loss or a biopsy to check for immune cells on the scalp near the follicle.

Though there’s currently no cure for alopecia areata, this form of hair loss can be managed. Mild cases of alopecia areata often get better on their own with time, while moderate to severe cases often improve with medication.

If you think you might have alopecia areata, talk to your primary care provider or schedule an appointment with a dermatologist.

If appropriate, your healthcare provider might prescribe medication to control damage from your immune system and stimulate hair regrowth.

Treatments for alopecia areata include:

  • Topical corticosteroids. These medications are applied directly to the skin to control inflammation. Your healthcare provider may prescribe a corticosteroid to suppress your immune system and reduce inflammation in your scalp.

  • Intralesional steroids. These medications are injected directly into the skin to reduce the severity of alopecia areata. Steroid injections are considered the most effective form of treatment for patchy alopecia areata.

  • Topical immunotherapy. This type of treatment involves applying contact allergens to the scalp to produce an immune system reaction. Various allergens — including dinitrochlorobenzene (DNCB) and diphencyprone (DPCP) — are used.

  • Minoxidil. This medication can stimulate hair growth by moving hair follicles into the anagen phase of the hair growth cycle. Topical minoxidil may speed up hair growth after your scalp recovers from alopecia areata inflammation.

We offer several hair loss medications, such as minoxidil (including minoxidil foam and minoxidil liquid solution) and finasteride, as part of our range of men’s hair loss treatments.

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Lifestyle Habits to Help Manage Alopecia Areata

As with most things hair loss, alopecia areata is best solved with a two-pronged approach. We talked about hair loss meds, but there are also lifestyle tweaks that might help and habits to avoid when dealing with alopecia areata.

For example, it’s helpful to use sunscreen to protect areas of your skin with noticeable hair loss from UV damage, which can further damage your scalp or face.

Some cosmetic treatments can help with alopecia areata temporarily, like styling your hair a certain way to cover the patches or wearing wigs.

Our volumizing shampoo, volumizing conditioner and thickening shampoo with saw palmetto can help your hair look thicker and more voluminous, making some bald spots less noticeable.

For more, read our blog on how to stop alopecia areata from spreading.

Now for some good news. One positive aspect of alopecia areata is that while the immune system attacks and damages hair follicles, the stem cells from which new hair grows are left unaffected.

This means that when alopecia areata is treated properly, it probably won’t result in the kind of permanent hair loss that’s common with male pattern baldness.

Put another way, alopecia areata is a non-scarring form of hair loss, so it generally doesn’t cause permanent follicular damage or create lasting marks on the affected parts of your body.

The not-as-good news? Hair regrows for some people with alopecia areata and not others. Those with less extensive hair loss, who have no nail changes, no family history of the disease and a later age of onset are more likely to see hair regrowth naturally.

Then there are the emotional effects of alopecia areata. If you feel stressed, anxious or depressed due to alopecia areata, it’s crucial to talk to a mental health professional or consider a support group for those struggling with hair loss or autoimmune disorders.

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Alopecia areata is significantly less common than male pattern baldness, but it’s still one of the most common causes of hair loss. So it’s good to be aware of the causes of alopecia areata, as well as its symptoms and treatment options.

Here are a few things to keep in mind about alopecia areata:

  • The biggest sign of alopecia areata is a patchy hair loss that looks different from a typical receding hairline or bald spot. It might look like chunks of hair are missing, and the patches may run into each other.

  • If you have alopecia areata, your healthcare provider will likely suggest medication, such as a corticosteroid, to reduce inflammation and protect your hair follicles. Make sure to closely follow your provider’s instructions and let them know if you have any side effects.

  • You can also use hair loss medications like minoxidil and finasteride to help regrow hair lost to alopecia areata.

Worried you may have another form of hair loss? We offer a wide range of hair loss treatments online, including evidence-based, FDA-approved medications for male pattern baldness.

You can get started today with an online consultation for hair loss or explore your options further with our guide to the best treatments for thinning hair.

16 Sources

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  2. McElwee, K.J., et al. (2013). What causes alopecia areata? Experimental Dermatology. 22 (9), 609-626. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094373/
  3. Lepe, K. & Zito, P.M. (2021, November 15). Alopecia Areata. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537000/
  4. Hoover, E., Alhajj, M. & Flores, J.L. (2021, July 26). Physiology, Hair. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499948/
  5. Pratt, C.H., et al. (2017). Alopecia areata. Nature Reviews. Disease Primers. 3, 17011. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573125/
  6. Singh, G. & Lavanya, M.S. (2010). Topical Immunotherapy in Alopecia Areata. International Journal of Trichology. 2 (1), 36-39. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002409/
  7. Badri, T., Nessel, T.A. & Kumar, D.D. (2021, December 19). Minoxidil. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482378/
  8. Alopecia Areata: Diagnosis, Treatment, and Steps to Take. (2021, April). Retrieved from https://www.niams.nih.gov/health-topics/alopecia-areata/diagnosis-treatment-and-steps-to-take
  9. AAD. (n.d.). Hair loss types. Alopecia areata causes. Retrieved from https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes
  10. Ho, C., Sood, T., Zito, P. (2022, Oct). Androgenetic Alopecia. StatPearls Internet. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430924/
  11. Benigno, M., Anastassopoulos, et al. (2020). A Large Cross-Sectional Survey Study of the Prevalence of Alopecia Areata in the United States. Clinical, Cosmetic and Investigational Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7131990/
  12. National Alopecia Areata Foundation. (n.d.) Alopecia Areata. https://www.naaf.org/alopecia-areata/
  13. Villasante Fricke, A. C., & Miteva, M. (2015). Epidemiology and burden of alopecia areata: A systematic review. Clinical, Cosmetic and Investigational Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521674/
  14. Vidal, C. I. (2015). Overview of Alopecia: A Dermatopathologist’s Perspective. Missouri Medicine, 112(4), 308-312. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170065/
  15. Aboud, A., Zito, P. (2023).Alopecia. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK538178/
  16. Gokce, N., et al. (2022). An overview of the genetic aspects of hair loss and its connection with nutrition. Journal of Preventive Medicine and Hygiene. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9710406/
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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Knox Beasley, MD

Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA. 

Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world. 

Dr. Beasley is board certified by the American Board of Dermatology, and is a Fellow of the American Academy of Dermatology.

Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time. 

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