Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss. It affects roughly 6.8 million people in the United States.
Hair falls out in small patches about the size of a quarter in the majority of cases. For the most part, hair loss is limited to a few patches, though it can be more severe in some cases.
It can sometimes result in total hair loss on the scalp (alopecia totalis) or, in severe cases, the entire body (alopecia universalis).
Anyone, regardless of age or gender, can be affected, though the majority of cases occur before the age of 30.
The causes and symptoms of alopecia areata, as well as its diagnosis and treatment options, are discussed in this article.
What is alopecia areata?
Alopecia areata is a condition in which a person’s hair falls out in patches. (Alopecia is a medical term for hair loss, and there are several types, including alopecia areata.)
Who gets alopecia areata?
While anyone can develop alopecia areata, some people are at a higher risk than others. Those who are most likely to get it have the following characteristics: A blood relative suffering from alopecia areata: It’s estimated that 10% to 20% of people with alopecia areata have a family member who also has the condition.
However, your chances of having alopecia areata are slightly greater if you have a relative with the condition. In addition, alopecia areata occurs more often among people who have family members with autoimmune disorders such as diabetes, lupus or thyroid disease.
SYMPTOMS AND CAUSES – What are the causes and symptoms of alopecia areata?
Alopecia areata is an autoimmune disease, where a person’s immune system attacks the body, in this case, the hair follicles. When this happens, the person’s hair begins to fall out, often in clumps the size and shape of a quarter. The extent of the hair loss varies; in some cases, it is only in a few spots. In others, the hair loss can be greater. On rare occasions, the person loses all of the hair on his or her head (alopecia areata totalis) or entire body (alopecia areata universalis).
It is believed that the person’s genetic makeup may trigger the autoimmune reaction of alopecia areata, along with a virus or a substance the person comes into contact with.
Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique. Even if someone loses all of his or her hair, there is a chance that it will grow back.
MANAGEMENT AND TREATMENT – How is alopecia areata treated?
Alopecia areata cannot be cured; however, it can be treated and the hair can grow back.
In many cases, alopecia is treated with drugs that are used for other conditions. Treatment options for alopecia areata include:
- Corticosteroids: anti-inflammatory drugs that are prescribed for autoimmune diseases. Corticosteroids can be given as an injection into the scalp or other areas, orally (as a pill), or applied topically (rubbed into the skin) as an ointment, cream, or foam. Response to therapy may be gradual.
- Rogaine ® (minoxidil): this topical drug is already used as a treatment for pattern baldness. It usually takes about 12 weeks of treatment with Rogaine before hair begins to grow.
Other drugs that are used for alopecia with varying degrees of effectiveness include medications used to treat psoriasis and topical sensitizers (drugs that are applied to the skin and cause an allergic reaction that can cause hair growth).
Living with alopecia areata
Apart from drug treatments, there are various cosmetic and protective techniques that people with alopecia can try. These include:
- Use makeup to hide or minimize hair loss.
- Wear sunglasses to protect the eyes from the sun and the environment (if there is loss of eyelashes).
- Wear coverings (wigs, hats, or scarves) to protect the head from the elements.
- Eat a well-balanced diet. Hair growth is a vitamin- and mineral-dependent process. People on fad diets often have problems with hair loss (although not specifically related to alopecia areata.)
- Reduce stress. Although never proven through large trials and investigations, many people with new onset alopecia areata have had recent stresses in life, such as work, family, deaths, surgeries, accidents, etc.
Fast facts on alopecia areata
Here are some key points about alopecia areata. More detail and supporting information is in the main article.
- One in five people with alopecia areata also has a family member who has experienced the condition.
- Alopecia areata often develops suddenly, over the course of just a few days.
- There is little scientific evidence that alopecia areata is caused by stress.
- People with alopecia areata who have only a few patches of hair loss often experience a spontaneous, full recovery, without the need for treatment.
- There is no cure for alopecia areata.
There is currently no cure for alopecia areata, although there are some forms of treatment that can be suggested by doctors to help hair re-grow more quickly.
The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These are mostly commonly administered through local injections, topical ointment application, or orally.
Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE, and DPCP. Although some of these may help with the re-growth of hair, they cannot prevent the formation of new bald patches.
The use of photochemotherapyTrusted Source is supported by some studies and presents a potential alternative for patients unable or unwilling to use systemic or invasive therapies.
In addition to its aesthetic aspect, hair affords a degree of protection against the elements. People with alopecia areata who miss the protective qualities of hair may wish to:
- Wear sunscreen if exposed to the sun.
- Wear wraparound glasses to protect the eyes from the sun and debris which the eyebrows and eyelashes would normally defend against.
- Use headwear such as hats, wigs, and scarves to protect the head from the sun or keep it warm.
- Use ointment inside the nose to keep membranes moist and to protect against organisms that are normally trapped by nostril hair.
Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.
Support groups and counseling are available for people to share their thoughts and feelings, and to discuss common psychological reactions to the condition.
Alopecia areata has been compared by some to vitiligo, an autoimmune skin disease where the body attacks melanin-producing cells, leading to white patches. Research suggests that these two conditions may share a similar pathogenesis, with similar types of immune cells and cytokines driving the diseases and common genetic risk factors.
As such, any new developments in the treatment or prevention of either disease may have consequences for the otherTrusted Source.
There have been a handful of documented cases where treatment for alopecia areata using diphencyproneTrusted Source (DCP), a contact sensitizer, has led to the development of vitiligo.
Preliminary research in animals has found that quercetin, a naturally occurring bioflavonoid found in fruits and vegetables, can protect against the development of alopecia areata and effectively treat existing hair loss.
Further research is needed, including human clinical trials, before quercetinTrusted Source can be considered a treatment for alopecia areata.
Alopecia areata Causes
The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way.
While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.
Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy, a disorder characterized by a tendency to be hyperallergic, thyroiditis, and vitiligo.
Despite what many people think, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the condition, but most recent research points toward a genetic cause.
Alopecia areata Home remedies
As conventional treatments for alopecia are extremely limited, studies that support natural treatments for alopecia are even thinner on the ground.
There are some people that recommend rubbing onion or garlic juice, cooled green tea, almond oil, rosemary oil, honey, or coconut milk into the scalp. While none of these are likely to cause harm, their effectiveness is also not supported by research.
Some people turn to alternative treatment methods such as acupuncture and aromatherapy, although there is little, if any, evidence to support these treatments.
Causes of alopecia in females
Alopecia can affect your entire body or just your scalp, and it can be temporary or permanent. It could be caused by heredity, hormonal changes, medical conditions, or simply aging. Men are more likely than women to lose hair on their heads.
Excessive hair loss from the scalp is commonly referred to as baldness. The most common cause of baldness is hereditary hair loss as people get older. Some people would rather leave their hair loss untreated and unnoticed. Hairstyles, makeup, hats, and scarves may be used to conceal it. Others opt for one of the available treatments to prevent further hair loss or to restore hair growth.
Hair loss can appear in many different ways, depending on what’s causing it. It can come on suddenly or gradually and affect just your scalp or your whole body.
Signs and symptoms of hair loss may include:
- Gradual thinning on top of head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair. An increasingly common hair loss pattern in older women is a receding hairline (frontal fibrosing alopecia).
- Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls out.
- Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary.
- Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
- Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.
When to see a doctor
If you or your child is experiencing persistent hair loss and would like to seek treatment, see your doctor. If you have a receding hairline (frontal fibrosing alopecia), talk to your doctor about getting treatment as soon as possible to avoid permanent baldness.
When combing or washing your or your child’s hair, talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss. Sudden hair loss can be a sign of a medical problem that needs to be addressed.
Alopecia areata Findings
People typically lose 50 to 100 hairs a day. This usually isn’t noticeable because new hair is growing in at the same time. Hair loss occurs when new hair doesn’t replace the hair that has fallen out.
Hair loss is typically related to one or more of the following factors:
- Family history (heredity). The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair along the crown of the scalp in women.
- Hormonal changes and medical conditions. A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems. Medical conditions include alopecia areata (al-o-PEE-she-uh ar-e-A-tuh), which is immune system related and causes patchy hair loss, scalp infections such as ringworm, and a hair-pulling disorder called trichotillomania (trik-o-til-o-MAY-nee-uh).
- Medications and supplements. Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout and high blood pressure.
- Radiation therapy to the head. The hair may not grow back the same as it was before.
- A very stressful event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.
- Hairstyles and treatments. Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot-oil hair treatments and permanents also can cause hair to fall out. If scarring occurs, hair loss could be permanent.
