Understanding Alopecia Areata

Alopecia areata is a condition that causes your hair to fall out. Alopecia means hair loss. Areata means patchy. This disease causes bald patches on the scalp, but it can also cause hair loss on other parts of the body.

Alopecia areata can affect both children and adults. It's more common as you age. It often starts around age 32 in males and age 36 in females.

 How to say it

al-oh-PEE-sha ar-ee-AH-tuh

What causes alopecia areata, and what are the risk factors?

Alopecia areata is an autoimmune disease. This means it’s caused by the body’s immune system attacking its own tissues. The immune system attacks the hair follicles. It causes hair to stop growing and then break off and fall out. Genetic (inherited condition) and other factors, such as smoking, may set off this condition.

If you have been diagnosed with alopecia areata, you may have a higher risk for:

• Another autoimmune disease, such as thyroid disease or vitiligo.

• Asthma and allergies, such as eczema (atopic dermatitis) and hay fever.

Symptoms of alopecia areata

The main symptom is one or more well-defined, circular bald patches on the scalp that occur over a few weeks as hair falls out.

Significant hair loss happens in a very short period.

Bald patches most often occur on the scalp, but hair can also fall out on the face and other parts of the body. The skin in the area may have a mild tingly feeling, itching, or mild pain. Then the skin may be smooth, or it may have some short hairs left. In some people, the rest of the hair on the head and the entire body may also thin or fall out.

Hair loss and regrowth can occur at the same time in different areas of the body. Hair loss may occur during colder winter months. Some people also have small dents or pits in their fingernails or toenails. Other symptoms may include roughness, cracks, white spots or lines, and loss of shine on the nails.

Diagnosis may be based on:

• Your medical history.

• A physical exam.

• Tests, such as:

  • Pull test. This test checks different parts of your scalp for active (current) hair loss. Your health care provider will gently pull on some hair—about 40 strands. If more than 6 strands come out, this is active hair loss.

  • Tug test. A few strands of hair are tugged gently. This is to check if any strands break.

  • Card test. Your provider holds a felt card against your skin in a parting of your hair. The tiniest of hairs or broken strands, which might not be seen otherwise, will show against the felt.

• Other tests include:

  • Blood tests. These tests are to see if you have a blood or thyroid disease or condition that causes hair loss.

  • Cultures. These are done to check for infections caused by a fungus or bacteria.

  • Scalp biopsy. This is done to examine your scalp. A small section of skin is removed and sent to a lab for testing.

  • Light microscopy. This is to examine hair that has been trimmed from your scalp.

Treatment for alopecia areata

You can choose not to have any treatment. For many people, the hair will grow back in time. In some cases, it may fall out again. While there is no cure, there are alopecia areata treatments that may help both adults and children with hair regrowth. Treatment depends on the extent of the disease and the person's age.

Some medicines can help regrow hair faster or stop hair from falling out. These medicines include:

• Corticosteroid medicine. This is injected into the areas where hair is falling out or gone. The injections are done every 4 to 12 weeks. This medicine can also be used as an ointment or cream put on the skin. These are often used along with the injections. Oral corticosteroids may be helpful in people who have rapid and extensive hair loss, because these medicines work throughout the body.

• Immunotherapy medicine. This is a type of medicine that you put on the skin to cause an allergic reaction on the skin. The goal of this treatment is to get your immune system to stop attacking your hair follicles and causing widespread hair loss.

• Topical minoxidil. You put this over-the-counter medicine right on the scalp. It may help new hair grow.

• Other medicines. Many other medicines can be used, but they may suppress the immune system. They can have unwanted side effects. Some newer immunologic medications, originally developed for other diseases, are showing promising results in early studies.

Medicines used for treatment have side effects. They also work better on some people than others. It depends on how bad your hair loss is. Talk with your health care provider about what medicines are the best choices for you.

Living with alopecia areata

For many people, the hair grows back within a year. But your hair may fall out again in the future. This process may occur a few times over several years. Or the hair may not fully grow back. In some people, all the scalp hair or body hair may fall out.

Hair loss is more likely to happen again if you have:

• Hair loss for more than 1 year.

• Nail symptoms.

• A family history of alopecia areata.

• Hair loss that started in childhood.

• Loss of a lot of hair.

• Loss of hair in a band from the ears around the back of the head.

Hair loss can cause stress and other emotional upset. Talk with your health care provider about finding support groups in your area to help you manage your condition. You can also talk to your provider about cosmetic fixes. A wig can hide bald patches. Tattooing of the eyebrows can restore the look of eyebrow hairs. Your provider may have resources to help.

When to call your doctor

Contact your health care provider right away if you have:

• Symptoms that don’t get better or that get worse.

• New symptoms.