Alopecia is a general term for hair loss. It’s normal to lose up to 100 hairs a day, often without noticing. This isn’t usually anything to be worried about. There are different types of alopecia, from hair thinning to complete hair loss. There are different types of alopecia. It usually causes small, round patches of baldness on the scalp. However, it can affect other areas including the eyebrows and eyelashes. It’s not possible to tell how much hair you’ll lose, or how quickly it’ll grow back. Hair can sometimes regrow white. In some areas, it will not regrow at all.
The cause of alopecia areata isn’t fully understood but it’s thought be an autoimmune condition. A close up view of the top of someone’s head. They have long dark hair with a bald circle in the centre of the scalp. A close up view of the lower half of a man’s face. The image is take from the left so only the side of the man’s face is visible. He has white skin with dark stibble around his mouth and chin.
Telogen effluvium is increased shedding of the hair. Male pattern hair loss is hair thinning or baldness that occurs in adult men. Female pattern hair loss is usually thinning of the hair at the top of the head. A close up view of the back of a man’s head. The man has white skin and fair hair. A close up view of the top of someone’s head. They have long brown hair with a straight parting in the centre of the head. Frontal fibrosing alopecia is a type of scarring alopecia that affects the area across the hair line.
You should speak to your GP practice if you’re worried about hair loss. They’ll normally ask about your hair loss and examine your hair to help find out the cause. Your GP practice may refer you to your local dermatology department. Before going to a private hair clinic, speak to your GP. Wigs or hair pieces can help build your confidence while you wait for your hair to regrow. Alopecia doesn’t pose a serious threat to your health. However, it can be distressing and can have a negative impact on your quality of life. If your mental health and wellbeing is affected, speak to your GP practice. They may be able to suggest where you can get support.
This leaflet has been written to help you understand more about alopecia areata. Alopecia is a general term for hair loss. Non-scarring hair loss means that the roots of the hairs have not been permanently lost; therefore, the hair potentially can grow back. It usually causes small, coin-sized, round patches of baldness on the scalp, although hair on other parts of the body, such as the beard, eyebrows, eyelashes, body, can be affected. In some people, larger areas are affected and occasionally it can involve the whole scalp (alopecia totalis) or the entire body, face, and scalp (alopecia universalis). Nails can also be seen in some patients.
It is not possible to predict how much hair loss alopecia areata will cause. Hair can regrow on its own over a period of months, and rarely, over years. However, this cannot be guaranteed and there is a risk of new patches occurring in the future. The chances of the hair regrowing on its own are better if less hair is lost at the beginning. If more than half of the hair is lost, then the chances of a full recovery are low. The hair sometimes regrows white, at least in the first instance. Most people get further episodes of alopecia areata.
A UK based study has demonstrated that people affected by alopecia areata have higher rates of depression and anxiety than those without alopecia areata, which can impact on their daily activities. Therefore, it is important to discuss with your healthcare professional the social or emotional impacts that you might be feeling. Hair loss in this condition is caused by inflammation of the hair follicle. Studies have shown that our immune system, the natural defence which normally protects the body from infections and other diseases, mistakenly attacks the hair follicle, stopping it from growing hair. Alopecia areata cannot spread to others and there is no connection to food or diet. There are several theories regarding triggers for alopecia areata, including previous infections and stress. Alopecia areata is an autoimmune condition and has been linked to other conditions such as thyroid disease, vitiligo (white patches in the skin) and type 1 diabetes. It has also been linked to atopic conditions such as eczema, hay fever and asthma.
Skin Pigmentation and Coexisting Conditions
Is alopecia areata hereditary? There is a genetic predisposition to alopecia areata. However, not everyone develops hair loss: we know that in about 2 out of 10 people affected by alopecia areata, there is a family history of the condition. Alopecia areata causes sudden hair loss which can affect any parts of the body. There may be itching, burning, or tingling sensation in the affected area before or after the hair loss. If eyelashes are affected, it may cause dry eyes and become sore in dry and windy weather. Typically, alopecia areata starts with one or more bald, smooth patches on the scalp. These patches are not inflamed or scaly. It often affects pigmented hair, so there may be some white hair left within the bald area, especially in older people. In this condition, short, tapered hairs, called exclamation mark hairs may be seen at the edge of the bald patch.
How is alopecia areata diagnosed? This condition is normally diagnosed following assessment by your doctor. Most patients do not require any tests to confirm the diagnosis.
Can alopecia areata be cured? Depending on the extent of hair loss there is a good chance that, for 4 out of 5 affected people, complete regrowth will occur within 1 year without treatment. There may, however, be further episodes of hair loss in the future. If there is very extensive hair loss from the start, the chances of it regrowing are not as high. Those with more than half the hair lost at the beginning, or with complete hair loss at any stage, have only about a 1 in 10 chance of full recovery. Some individuals with alopecia areata may prefer to wear a wig while they wait for recovery. Your local hospital orthotic (surgical appliances) department will be able to advise you on the range of hairpieces available on the NHS and can recommend local suppliers who are sensitive to the needs of individuals with alopecia areata. People with mild alopecia areata may not require treatment as their hair may regrow on its own. There is currently no cure for this condition, and the aim of treatment is to help with symptoms of hair loss. The treatments that can be considered depend on the severity of hair loss.
Wigs/ hair pieces can be a vital treatment for some patients in helping them regain confidence. The availability and provision of wigs are very variable across the UK. Alopecia UK and the British Association of Dermatologists have tried to address this by creating a Charter for Best Practice for NHS Wig Provision. Hair fibres or cosmetics can help camouflage the areas of hair loss. They can be bought online or over the counter. Microblading for eyebrows can help in cases of severe or permanent eyebrow loss.
Corticosteroid creams and scalp applications. These are applied to the bald patches on the scalp for around 6 weeks. Topical Janus kinase (JAK) inhibitors to treat alopecia areata have been studied through clinical trials and shown that they are not effective in regrowing scalp hair. Reports in the medical literature suggest possible improvement with eyebrow and eyelash regrowth. More studies are needed to review their effect. Dithranol cream. This cream, which is usually used to treat a skin condition called psoriasis, causes irritation of the skin, and occasionally this appears to stimulate the hair to regrow when applied to the bald areas of the scalp. Dithranol stains the skin and hair a purple-brown colour, which is particularly prominent in blond and fair-headed people. It is not readily available, as there have been manufacturing issues over the years. Contact sensitisation treatment. This involves making the patient allergic to a substance (usually a chemical called diphencyprone) and then applying very weak strengths of this chemical to the bald patches, usually once a week to maintain a mild inflammation. Side effects of possible itching, blistering and enlarged glands in the neck can be troublesome. Some people can get widespread eczema. Prostaglandin analogs. Latanoprost and bimatoprost are types of eyedrops that are used to treat glaucoma (raised pressure in the eyeball). One of the side effects noted in glaucoma patients was increased hair growth of eyelashes with its use. Minoxidil lotion. This is available over the counter. Applied to bald patches or areas of early regrowth with fine hair. There is limited evidence of how effective it can be when used on its own. It can sometimes help boost regrowth when used alongside other treatments. Local steroid injections. These can be used on the scalp and eyebrows and are the most effective approach for small patches of hair loss. Injections can be repeated and are stopped once regrowth is achieved. A small dimple may develop at the injection sites, but this usually recovers after a few months. Special care is taken around the eyes and eyebrows. Corticosteroid tablets. High doses of steroid tablets may be effective in regrowth of the hair in moderate to severe cases, especially early on in their disease. However, there is a risk of relapse of hair loss once treatment is stopped. Long-term use of steroid tablets is not recommended. Oral JAK inhibitors. Oral JAK inhibitors are the first class of tablet treatments (taken by mouth) licensed for the treatment of severe alopecia areata. JAK inhibitors are immunomodulatory drugs. This means that they work by blocking a group of proteins in the body called Janus kinases (JAKs). JAK proteins are part of our immune system and play a role in causing inflammation. JAK inhibitors carry a risk of infection as a side effect. Tofacitinib can be used to treat patients for other conditions beyond alopecia areata. When tofacitinib has been used in some of these contexts (for example, to treat people with rheumatoid arthritis), it has been linked with higher rates of heart-related events, cancers, blood clots and serious infections. Baricitinib (JAK 1 & 2 inhibitor) is also a tablet taken daily. It has been licensed for its use in severe alopecia areata. However, it has not been approved for NHS funding for alopecia patients currently due to cost. It is available on private prescriptions. More studies are taking place exploring other tablet-based JAK inhibitors and their potential use in alopecia areata. Immunosuppressant tablets. These tablets include methotrexate, ciclosporin, mycophenolate mofetil and azathioprine. These medications are used in other inflammatory skin conditions such as psoriasis and eczema. These medications are considered in severe alopecia areata when other treatments have failed. They work by suppressing the immune system and therefore, several serious side effects have to be considered when starting these medications. Biological therapies. These are drugs that can mimic or block the way in which immune cells signal to each other, so can decrease inflammation. Dupilumab (interleukin 4 and 13 inhibitor) is currently licensed and funded on the NHS for the treatment of atopic dermatitis from the age of 6 months, and not alopecia areata. There is a suggestion from a clinical trial that dupilumab can potentially help hair regrowth in certain cases, specifically people affected by both atopic dermatitis and alopecia areata. Several other biological agents have been reviewed with limited evidence. Ultraviolet light treatment (PUVA). This involves taking a tablet or applying a cream that makes the skin sensitive to light. The bald patches are then exposed to ultraviolet light, two or three times a week for a number of months. Recurrence of hair loss is common when the treatment is stopped. Complementary & alternative medicine (CAMs). There is very limited evidence in the medical literature regarding alternative therapies. Psychological-based treatments. Small studies have suggested that hypnosis and mindfulness meditation are effective for improving psychological wellbeing and quality of life in patients with alopecia areata.
Remember that an important function of hair is to protect the scalp from sunlight. The hair also acts as an early warning to prevent scraping the scalp on low doors, cupboards, or trees. People with long hair may use hair extensions to conceal it. Some hairdressers specialise in this. It is important to avoid putting too much tension on the hair during the process. Artificial eyelashes, eyebrow pencils and eyebrow tattoos/ microblading may be helpful for people with hair loss around the eye area. Please note that the British Association of Dermatologists (BAD) provides web links to additional resources to help people access a range of information about their treatment or skin condition.
Alopecia areata is a common skin disease. The word alopecia means bald; areata means patchy. The disease causes hair loss on the scalp, face, and sometimes other body areas, like under the arms or on the legs. People with alopecia areata most often lose hair in circular, coin-sized patches on the scalp, but in more severe cases, they may lose all of their hair. What Is Alopecia Areata? Alopecia areata is a common autoimmune skin disease. The word alopecia means bald; areata means patchy. The disease causes hair loss on the scalp, face, and sometimes other body areas, like under the arms or on the legs. What does this mean? and 160 million worldwide have alopecia areata or have had, or will have it.
Who gets it? People of all ages, genders, and racial and ethnic groups are affected by the alopecia areata. Although alopecia areata can begin at any age, most individuals develop the disease early in life. More than 80% show signs of the disease before age 40, and 40% experience symptoms by age 20. Research suggests that women are more likely to develop alopecia areata than men and people of some races and ethnicities may have a higher chance of developing the disease. Alopecia areata is a polygenic disease, meaning it is related to multiple genetic factors. But not everyone with the genes develops the disease. The disease is a complex one. Scientists know it is an autoimmune disease, but they aren’t sure why the immune system attacks the healthy hair follicles of people with the gene variations in the first place. About 20% of people with alopecia areata have at least one family member who also has the disease. The risk of alopecia areata increases if you have a close relative with it. Another thing researchers aren’t sure about is what triggers the disease. They know that people with alopecia areata have a genetic predisposition (increased likelihood) to it, but how is it triggered?
All types of alopecia areata result in some form of hair loss. If you have alopecia areata, there is no way to predict the pattern of hair loss and regrowth or how severe or long-lasting it will be. That said, there are some common symptoms of alopecia areata that are good to know and recognize. There are more than 80 autoimmune diseases. It’s not uncommon for someone to have more than one at the same time and alopecia areata often occurs with other autoimmune conditions. These include thyroid disease or type 1 diabetes. Having alopecia areata can be frustrating and emotionally challenging because hair loss and regrowth are unpredictable. But you are not alone!
Although alopecia areata can occur at any age, it does start most often during childhood. Parenting a child with the disease can be challenging. How will alopecia areata affect my life? Unlike most autoimmune diseases, alopecia areata does not generally cause physical discomfort or disability. However, hair loss can be difficult for many people. It can have a significant impact on their mental health, affecting how they feel about themselves. Different people have different ways of coping with their hair loss. Some wear wigs or use camouflage techniques to hide the bald areas, while others don’t bother hiding it at all.
A note from Cleveland Clinic: It can be alarming to notice hair loss. Alopecia areata is a common condition that causes hair loss anywhere on your body, but it usually affects your scalp. Reach out to your healthcare provider as soon as you notice hair loss, especially if it causes stress, anxiety or depression.
Alopecia Areata Series: Part One: A Clinical Overview
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