Although the condition attacks hair follicles, it doesn’t destroy them, so there is no scarring and hair will re-grow over time. Children, teens, and adults can be affected and genetics play a part in who develops it. Even though alopecia areata usually resolves itself, some treatment options exist, as well as coping strategies when hair loss causes anxiety and embarrassment.
Symptoms of Alopecia Areata
People who have this condition are, for the most part, otherwise healthy. Alopecia areata is not a sign or symptom of a more serious or underlying condition.
The most common symptoms of alopecia areata include:
Round or oval patches of baldness on hair-bearing areas. Possible burning or tingling in the area, though this isn’t always the caseHealthy-looking skin where the hair loss occurred, with no signs of rash or irritationRapid hair loss, sometimes within just a few daysHair regrowth in one area while falling out in another
“Exclamation-mark” hairs may be seen at the margin of the patch. These are broken, short hairs that taper at the base. Pulling slightly on these hairs causes them to fall out.
Note: Some cases may cause widespread hair loss including total baldness (alopecia totalis) and loss of all body hair (alopecia universalis).
Causes
Alopecia areata is an autoimmune disorder, which means the body’s immune system, for unknown reasons, attacks the hair follicles causing hair loss.
Softer or brittle nailsPinpoint dents or ridges across the nailNails that feel rough or “sandpaper-like"Red coloration of the nail bed
When the immune system perceives a threat from an outside intruder (bacteria, for example), the body responds by sending inflammatory substances to the affected area. In the case of alopecia areata, even though a threat doesn’t exist, the body creates antibodies to its own hair follicle structures.
The “life” of a hair has three phases: anagen (growth), catagen (maturity), and telogen (death, or falling out). Normally, all hair goes through these stages at random and the growing hairs on the rest of the head outnumber the hairs that fall out.
Alopecia areata’s inflammatory immune response triggers a premature telogen or late catagen stage within the hair follicles.
Risk Factors
Alopecia areata is fairly common, with up to 2% of the population experiencing it at some point.
The condition can occur at any age. However, the vast majority of people who develop alopecia areata are under 30, and many are children and teenagers. Early-onset alopecia areata, defined as occuring between ages 5 and 10, tends to be most severe.
Certain factors make a person more likely to develop the condition:
Genetic predisposition: Approximately 18% of people with alopecia areata have a close relative with the condition. Atopic conditions: Atopic dermatitis (eczema), allergies, and/or asthma may raise the risk. Autoimmune diseases: Thyroid conditions, lupus, psoriasis, rheumatoid arthritis, or vitiligo may contribute. Race: A 2018 analysis found alopecia areata to be more common in people who are Black or Hispanic, at least in the case of women. More research is needed to see if that holds true for both sexes. Cold weather: Low temperatures don’t cause alopecia areata, though wintry weather can be a trigger for those who already have the condition. A 2018 study in the Journal of the American Academy of Dermatology showed some hair loss flares happening more often during the winter months with periods of regrowth during the summer.
Diagnosis
No specific test exists to diagnose alopecia areata. In most cases, your healthcare provider should be able to diagnose alopecia areata by a physical exam of your hair and nails, taking a detailed medical history into account.
Your healthcare provider may also do some blood tests to look for autoimmune diseases and to rule out other diseases that may mimic alopecia areata, such as:
Telogen effluvium: Generalized hair loss caused by pregnancy, certain drugs, high fever, or stressAndrogenic alopecia: Also known as male-pattern baldnessTrichotillomania: Manually pulling the hair out caused by a psychological disorderSecondary syphilis: A “moth-eaten” baldness pattern over the entire scalp
Treatment
Alopecia areata can’t be cured. However, in the majority of patients, the hair will regrow completely within one year without any treatment.
That said, because hair loss can be embarrassing and cause anxiety, the condition can be treated. It’s important to note that treatment isn’t always necessary or advisable. The decision to treat alopecia areata depends on many factors, including the age of the person affected, the severity of the hair loss, and where the hair loss is occurring.
Topical steroids. This is a first-line treatment for both children and adults. Applying a strong topical steroid such as Diprolene (betamethasone) or Temovate (clobetasol) to the patch may stimulate hair regrowth. It may take several months for the hair to grow back using this method.
Steroid injection. This is considered the treatment of choice for adults with alopecia areata of the scalp or eyebrows. A healthcare provider will inject a steroid such as triamcinolone acetonide or Celestone (betamethasone) into the affected skin.
Initial regrowth of hair can be seen in four to eight weeks, with treatments being repeated every four to six weeks. The main side effect of any steroid use is thinning of the skin. These injections are not used in children younger than 10 years old.
Rogaine or Theroxidil (minoxidil). This hair growth drug has shown cosmetically acceptable results in 30% of cases. This medication is applied topically to affected areas and comes in either a foam or a solution.
Minoxidil does not stop the disease process, so stopping applications after hair has started to grow back may cause the hair to fall out again.
Because minoxidil is relatively safe, it’s considered a good treatment choice for young children.
Topical contact sensitizers. This type of treatment is designed to produce a contact dermatitis, or irritation, at the site in order to stimulate hair growth. The most common irritant used is called anthralin.
Oral Steroids. Medications such as prednisone are not used as first-line treatment but they may be prescribed in severe cases of widespread hair loss, as in the case of alopecia totalis or universalis.
Taking a short course of oral steroids for about six weeks can regrow hair. Because of the risk of side effects, oral steroids should not be taken long term. Also, once oral steroids are stopped the new hair may fall out again.
After oral steroids are stopped most people are switched over to another treatment to continue hair regrowth.
Janus Kinase (JAK) inhibitors. These drugs, which include Xeljanz (tofacitinib), Opzelura (ruxolitinib), and Olumiant (baricitinib), blunt inflammation by blocking signaling pathways during the immune response.
In research, they’ve shown short-term promise in treating alopecia and depending on the study cited, between 50% to 91% of people showed significant improvement.
In June 2022, the Food and Drug Administration (FDA) approved Olumiant (baricitinib) for the treatment of adults with severe alopecia areata. It is taken by mouth and is the first systemic treatment approved for alopecia areata. Olumiant is also approved for the treatment of adults with moderate to severe rheumatoid arthritis.
It’s important to note that there is an increased risk of heart-related events, like heart attack or stroke, in addition to cancer, blood clots, and death with the use of the JAK inhibitors Xeljanz, Olumiant, and Rinvoq.
Discuss these risks with your healthcare provider to determine if JAK inhibitors are a safe option for you.
Coping
The sudden and unpredictable nature of this type of hair loss can be difficult to cope with, especially for children and teens. People of all ages can experience a loss of self-esteem, or even depression or anxiety that may be severe enough to require the help of a therapist.
Helpful coping strategies for alopecia areata include:
Wigs and hair pieces: Some people may wish to consider wigs, hairpieces, or hair prostheses. There is a vast array of options available for adults and children. False lashes: For eyelash loss, temporary lashes can be applied with washable adhesive. Semi-permanent lashes last up to eight weeks. These can be applied by trained hairdressers or estheticians at a hair or salon, or spa. Support groups: Connecting with others dealing with hair loss can be extremely helpful. The National Alopecia Areata Foundation can help connect you to local support groups and also offers phone support by peer mentors.
A Word From Verywell
Alopecia areata is a challenging condition. In many people, it resolves spontaneously with complete hair growth, but they must deal with rapid and noticeable hair loss in the meantime. Talk to your healthcare provider not just about potential treatments, but cosmetic options to reduce embarrassment and anxiety.
