Exclamation Point Hairs: A Sign of Alopecia Areata?

Have you ever had hair that looks like it’s so excited it can’t decide which direction to grow? Enter the world of exclamation point hairs —  fragile, short hairs that are thinner near the scalp than at the ends. 

Hair can take on different looks throughout our lives, whether because of changes we make ourselves (like a haircut) or factors out of our control — like genetics, age, hormones, or an autoimmune condition like alopecia areata.

But exclamation point hair may not be quite the look you’re going for. While they might seem like they're just here to add some drama to your hairline, these quirky little hairs actually have a lot more to tell you than you might think. Let’s take a closer look.

Exclamation point hair looks how it sounds — a short stub of hair that’s narrower at the base than the tip, creating the appearance of an exclamation point. Unfortunately, it doesn't connote the same type of enthusiasm as an exclamation point in your text thread to the guys. 

These hairs are typically short and thin at the base and thicker towards the tip, creating a distinctive tapered appearance. They stand out because of their odd shape, with the thinner base making them look almost as if they’ve been pinched. 

In some cases, exclamation mark hair appears when the hair follicle has grown, but the hair shaft (the visible part of hair) has broken off. In other instances, exclamation point hair may appear around the edges of a patch of hair loss.

You can see this exclamation point-like shape with the naked eye if you use a couple of mirrors to examine the hairs close to your scalp. But most people don't do this regularly unless they're experiencing weird hair or scalp symptoms. 

Exclamation point hairs are more than just a quirky trait. They can indicate more serious underlying issues related to your health and how your hair is growing. The most commonly associated root cause is called alopecia areata.

This is an autoimmune condition in which your immune system mistakenly perceives hair follicles as a threat and attacks them. 

This attack weakens hairs at the roots, which causes the characteristic stretched and tapered look of exclamation point hairs. As your hairs grow, their bases continue to thin until they break or the strand falls out altogether. 

Exclamation mark hairs and alopecia areata often go hand in hand. In fact, exclamation mark hairs are a common sign of this type of hair loss since they frequently occur as hair regrows in the hairless patches caused by alopecia areata.

The main difference between regular and exclamation point hairs is that regular, healthy hairs are uniform in thickness from the root to the tip. This is because they’re following the normal hair growth cycle, which includes these phases: 

• Anagen (growth phase): This is the active phase where hair cells quickly divide and grow the hair shaft. It can last for two to seven years, during which you generally experience a half-inch of hair growth each month. Nearly 85 percent of your hairs are in this phase most of the time, happily growing from their follicle. 

• Catagen (transition phase): This two to three-week phase of the cycle marks the end of active growth. Your hair follicles shrink, and the hair detaches from its blood supply as it transitions to the telogen phase. Just one percent of your hair is in this transition phase at any time. 

• Telegon (resting phase): This phase lasts approximately three months, during which your hair remains in its follicle without growing. Around 14 percent of your hair is in this phase at any time. 

• Exogen (shedding phase): This is when your hairs fall out to make space for new hairs. It often occurs at the same time as follicles re-enter the anagen phase.

When you have alopecia areata,  this normal hair growth cycle is disrupted, causing exclamation point hairs.

An autoimmune attack pushes your hairs out of their growth phase too soon, causing the base to weaken and taper in shape. While healthy hairs grow consistently and stay planted in your scalp, exclamation point hairs are likelier to break off.

If you have alopecia areata, your hair typically falls out in small, round patches about the size of a quarter, most commonly on your scalp. In some cases, hair loss might extend to the entire body, leading to patches of hair loss in your beard, eyebrows, or body hair.

While anyone can get this type of hair loss, people with autoimmune diseases, such as thyroid disease or psoriasis, may be more at risk.

How is Alopecia Areata Diagnosed?

Diagnosing alopecia areata requires your healthcare professional or dermatology provider to take a closer look at what’s going on near your scalp, assess your history, and sometimes do other tests. Here’s what you can expect: 

• Physical exam: Your provider will examine the affected areas to look for the hallmark signs of alopecia areata, such as well-defined, round bald patches of hair loss and exclamation point hairs. They may gently pull on hairs to see if they come out easily, suggesting active hair loss. 

• Medical history: This is the time to share any family history of autoimmune conditions or personal factors that may be contributing to hair changes, like ongoing stressors or recent illnesses. 

• Dermatoscopy: Sometimes, your provider will use a dermatoscope — a specialized magnifying tool — to get a closer look at your scalp and follicles. 

• Other tests: In some cases, your provider may take a small scalp biopsy to examine under a microscope or order blood tests to rule out other common causes of hair loss, like thyroid issues.

How is Alopecia Areata Treated?

As with other autoimmune conditions, there is no cure for alopecia areata. However, there are ways to help preserve and improve your hair health if you get a diagnosis of alopecia areata. 

Some common treatment options include: 

• Topical, oral, or injectable corticosteroids to reduce inflammation and the immune system’s attack on your follicles 

• Minoxidil (Rogaine®), which is available as a topical solution or foam, to promote hair regrowth by extending the anagen phase of the hair cycle

• Finasteride (Propecia®), an oral medication for thinning hair, works even better when paired with minoxidil (such as in our topical finasteride & minoxidil spray)

• Topical immunotherapy, such as diphenylcyclopropenone (DPCP) or squaric acid dibutyl ester (SADBE), to provoke an allergic reaction, which distracts the immune system from attacking the hair follicles. It can sometimes also promote hair growth.

• Oral immunosuppressants, such as methotrexate, cyclosporine, or JAK inhibitors (like tofacitinib and ruxolitinib), to suppress the immune system more broadly

• UV light therapy to help stimulate hair growth

While alopecia areata is the most common culprit behind exclamation point hairs, they can also result from hair growth after experiencing other types of hair loss, such as: 

• Androgenetic alopecia. Also known as male pattern baldness, androgenetic alopecia is the most common type of hair loss. It’s characterized by a receding hairline and scalp hair loss at the crown. If you start treatment for androgenetic alopecia, initial hair regrowth may result in exclamation point hair.

• Telogen effluvium. Another common form of hair loss, telogen effluvium, is usually caused by severe stress, illness, hormone changes, or certain types of medication interrupting the normal hair growth cycle. Telogen effluvium causes a noticeable loss of hair volume, but when spontaneous regrowth begins, you may have upright regrowing hairs, AKA exclamation mark hairs.

It can be hard to decipher whether alopecia areata, extreme stress, or male pattern baldness is to blame for your sudden eruption of exclamation point hairs. 

We recommend contacting a dermatologist or other healthcare provider who can help determine the pathogenesis of your hair loss and recommend an appropriate treatment plan.

Exclamation point hairs may not be life-threatening, but they’re not just a quirk. As with other bodily cues, these fragile hairs are trying to send you a signal about what’s happening beneath the surface. 

So, before you brush them off, keep these things in mind: 

• The most common cause is alopecia areata. Your healthcare provider can use a series of tests to determine whether you have this autoimmune condition or some other condition. 

• Treatments are available. While there’s no cure for alopecia areata, your provider can recommend ways to help you keep the hair you have and suppress your immune system's attack on your hair follicles. For example, treatments for hair loss may include topical options like steroids, minoxidil, or finasteride (or a combination of the two).

• Check on your hair. Whatever is going on with your hair can actually signal many things about your body. Spotting exclamation point hairs or other changes early can give you a head start in managing hair loss and getting your follicles back on track.

You can also check out our guide on how to stop alopecia areata from spreading for more information on this condition.