Alopecia areata is a type of hair loss that causes patchy hair loss all over the head and sometimes the entire body.
Alopecia areata is a type of hair loss that causes patchy hair loss all over the head and sometimes the entire body. The patches are usually round and about the size of a quarter, though they may be oblong and slightly bigger or smaller.
But what is alopecia, exactly? Is alopecia a disease? Alopecia is simply the medical term for any type of hair loss, and areata means it shows up in small, random areas.
Alopecia areata is an autoimmune disease that causes patchy hair loss. It develops when the immune system targets and attacks hair follicles.
Alopecia areata’s exact pathogenesis (how it develops and progresses) isn’t known. However, research suggests that both genetic and environmental risk factors (things like stress, infections, or smoking) play a part.
We’ll cover the symptoms, causes, and risk factors for alopecia areata, plus treatment options and prevention tips.
Before we dive into the symptoms of alopecia areata, it’s important to understand the three types:
Alopecia areata. Also called “patchy alopecia areata,” this 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.
Alopecia areata symptoms include:
Small round or oval-shaped patches of hair loss on the scalp
Patchy hair loss and broken hairs within 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 grow into large hairless areas
Changes in fingernails and toenails, including ridges and pits
If you’re experiencing any of these signs of alopecia areata, contact your healthcare provider.
What causes alopecia? It’s a great question that researchers are still working on.
The exact physiological cause (i.e., what happens inside the body) of alopecia areata isn’t entirely understood. But we do know alopecia areata is an autoimmune disorder that makes the immune system target hair follicles — the part of the hair responsible for growth.
Some research shows that a type of white blood cell called T lymphocyte infiltrates the hair follicle, creating an immune response. When the immune system attacks these white blood cells, it leads to inflammation and disrupts the normal hair growth cycle, causing hair to fall out.
Alopecia areata can also cause hair follicle miniaturization (this is also what happens with male pattern baldness). The immune system’s attack on hair follicles can make them shrink and enter the resting (telogen) phase of the hair growth cycle, leading to hair loss. This miniaturization of hair follicles ultimately results in the characteristic patchy bald spots seen in alopecia areata.
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.
Alopecia areata is 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.
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 in developing alopecia areata. Understanding these risk factors can give you an idea of the things to avoid when you have alopecia areata.
Risk 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 skin 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). Research also suggests a link between COVID-19 and alopecia areata.
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. This would sign you’re experiencing more than just normal shedding (which the American Academy of Dermatology defines as losing 50 to 100 strands a day).
In some cases, your provider may want to perform a blood test to rule out other causes of hair loss. They can also do a scalp 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 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 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 are used, including dinitrochlorobenzene (DNCB) and diphencyprone (DPCP).
Minoxidil. This FDA-approved medication can stimulate hair growth by moving hair follicles into the anagen (active growth) phase of the hair growth cycle. Topical minoxidil may speed up hair growth after your scalp recovers from alopecia areata inflammation.
Phototherapy. Phototherapy, also known as light therapy, is a treatment that uses specific wavelengths of light to treat various skin and hair conditions, including alopecia areata. In some cases, a drug called psoralen is combined with ultraviolet light to help treat alopecia areata.
We offer several hair loss medications — such as topical minoxidil (including minoxidil foam and minoxidil liquid solution) and finasteride — as part of our range of men’s hair loss treatments.
We also offer a topical finasteride & minoxidil spray, which combines both powerhouse ingredients in one quick-drying product. (Research shows that the two ingredients combined are more effective than either alone).
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 habits to avoid when dealing with alopecia areata and lifestyle tweaks that might help.
For example, it’s helpful to use sunscreen to protect areas of your skin with noticeable hair loss from sun 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.
Many people seeking treatment for the condition wonder if alopecia areata ever fully goes away. There’s no known cure for alopecia areata, but the symptoms may ebb and flow. Some people with alopecia areata will go on to experience hair regrowth.
The not-as-good news? Hair regrows for some individuals 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.
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 unaffected. This means that when alopecia areata is treated properly, it probably won’t result in permanent hair loss.
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.
Alopecia isn’t a life-threatening condition, but it can have psychological effects and cause reduced self-esteem. For this reason, it can be helpful to see a therapist to help manage some of the psychological pain and social anxiety that may come with the disease.
It’s difficult to prevent alopecia areata because it’s primarily caused by genetic and autoimmune factors that are largely out of your control.
But there are steps you can take to help manage the condition or reduce flare-ups:
Stress management. Stress is thought to be a potential trigger for alopecia areata. Stress-relieving activities like meditation, exercise, and relaxation techniques may help reduce the risk of flare-ups.
Early intervention. Speak to a healthcare professional when you notice the signs of alopecia areata (usually small bald patches). Early treatment with medications like corticosteroids or other immunosuppressive therapies can reduce the severity of hair loss, and hair loss medications encourage regrowth.
Avoid Known triggers. This is sometimes easier said than done, but if you’ve experienced flare-ups of alopecia areata in the past, pay attention to any patterns around what triggered it. Things like certain medications or intense stress may cause a flare-up and can be avoided in the future.
Healthy habits. Nutritious eating, regular exercise, and good sleep hygiene help support overall immune health. A healthy lifestyle can’t totally prevent alopecia areata, but it could reduce its severity.
Alopecia areata hair regrowth is possible. We can connect you with a healthcare professional online who can help you access the treatment you need.
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.