12423 Alopecia Areata

Overview

Alopecia areata is a common condition that causes hair to fall out in small, round patches. It happens when your body's immune system mistakenly attacks your hair follicles, the tiny pouches where hair grows. This is an autoimmune condition, which means the body is fighting against its own cells. It is not contagious, and for many people the hair grows back on its own.

Yes. Alopecia areata affects about 1 in 50 people at some point in their lives. It is one of the most common causes of hair loss in people under 30.

It can affect anyone, regardless of age, sex, or ethnicity. Children and young adults are often first affected, and people with a family history of alopecia areata or other autoimmune conditions such as thyroid disease, vitiligo, or type 1 diabetes have a higher chance of developing it.

Symptoms

Common symptoms

• Small, round, smooth bald patches on the scalp that may feel slightly itchy or burning before hair falls out.
• Hair loss that can also affect the beard, eyebrows, eyelashes, or other body hair.
• Nail changes, such as tiny dents, pits, ridges, or roughening of the fingernails and toenails.
• Hair that grows back white or fine before returning to its usual color and texture.

Symptoms in children

• Patchy hair loss on the scalp is the most common sign in children.
• Children may have nail pits or nail roughness alongside the hair loss.
• The onset can be sudden, and children may not notice it until someone points it out.

Symptoms in older adults

• Hair loss in older adults can be mistaken for age-related thinning, but alopecia areata tends to produce distinct round patches.
• It may be more extensive in older adults, and regrowth can be slower.
• Older adults may also have other medical conditions that affect treatment choices.

Causes

Main causes

• The immune system attacks hair follicles, stopping normal hair production and causing hairs to fall out.
• The exact trigger is not fully understood, but it is likely a combination of genes and environmental factors such as a viral illness, stress, or injury.
• Alopecia areata is not caused by poor hygiene, brushing too much, or dyeing hair.

Risk factors

• A family history of alopecia areata or other autoimmune conditions increases your risk.
• Having another autoimmune condition, such as eczema, hay fever, asthma, pernicious anaemia, or thyroid disease.
• Stress or a recent illness may sometimes trigger hair shedding or worsen the condition.

When to see a doctor

See a doctor urgently if:

• Seek urgent medical advice if you notice hair loss appearing suddenly and spreading quickly over a few days, or if you have additional symptoms such as severe scalp pain or rash.
• If you feel overwhelmed, anxious, or depressed about your hair loss, see a healthcare provider soon for support.

Book a routine appointment if:

• Make a routine appointment if you have one or more bald patches that do not heal or regrow within a few months.
• See your GP or a qualified healthcare provider if you are concerned about hair loss and would like a confirmed diagnosis.
• If you have nail changes along with hair loss, it is worth asking your doctor about them.

Diagnosis

A doctor can usually diagnose alopecia areata by examining your scalp and hair. They may gently pull on a few hairs to see if they come out easily, and they will look for the typical round patches. In most cases, no special tests are needed.

Tests that may be done

• A hair pull test: your doctor gently tugs several hairs to check if more than normal are loose.
• A scalp biopsy: a tiny sample of skin is taken from an affected area to look at under a microscope, usually only if the diagnosis is unclear.
• Blood tests: to check for other autoimmune conditions such as thyroid problems, anaemia, or vitamin deficiencies, especially if the doctor suspects an underlying cause.

What to expect at your appointment

Your doctor will look at your scalp, ask about your medical history, and may ask about family history of hair loss or other health conditions. The examination is quick, painless, and does not usually require preparation. You will be told if further tests are needed and what the next steps are.

Treatment

There is no cure for alopecia areata, but treatment can help hair grow back in many people. Some people improve without any treatment, especially when hair loss is limited to a few small patches. Treatment aims to suppress the immune attack on the hair follicles and encourage hair regrowth. Your healthcare provider can discuss the most suitable options for you.

Self-care at home

• Handle your hair gently: use a wide-tooth comb and avoid pulling hair into tight ponytails, braids, or buns.
• Protect affected skin from the sun with a hat, scarf, or sunscreen to prevent sunburn on exposed bald patches.
• Be patient: regrowth can take several months, and new hair may initially be white or very fine.
• Consider using a camouflage product (like a tinted powder, spray, or cover-up) for cosmetic confidence while you wait.

Medical treatments

Doctors may offer several treatment approaches. Injections of a weak corticosteroid solution are a common approach for small patches of hair loss that can be given in the doctor's office. Other options include topical treatments applied to the skin, such as corticosteroid creams or ointments, and a treatment called topical immunotherapy that deliberately causes a mild allergic reaction on the skin to confuse the immune system. For more extensive hair loss, a doctor might recommend systemic medications (taken by mouth or given as an injection) that alter the immune response. Phototherapy, which uses ultraviolet light on the skin, has also been used. No specific drug names are given here; always talk to your healthcare provider about the benefits and risks of any treatment.

When is surgery considered?

Hair transplant surgery is rarely used for alopecia areata, because the transplanted hairs may also fall out if the immune attack continues. This treatment is generally not recommended while the condition is active.

Living with this condition

Living with alopecia areata can be emotionally challenging, but you are not alone. You can choose to wear wigs, scarves, or hats, or you can embrace your natural look. Hair regrowth can be unpredictable, so it helps to focus on what you can control, such as protecting your skin and keeping your scalp healthy.

Lifestyle tips

• Find a gentle hair care routine: use mild shampoos, avoid heat styling, and limit chemical treatments.
• Wear a hat or use sun protection when going out in the sun.
• Join a support group or connect online to share experiences with others who have hair loss.
• Consider talking therapies if you feel anxious or down about your appearance – counselling can be very helpful.

Diet and exercise

There is no special diet that can cure alopecia areata, but eating a balanced diet rich in vitamins and minerals supports overall health and hair regrowth. Regular physical activity can help improve your mood and manage stress, which may be beneficial since stress can sometimes trigger hair shedding.

Mental health and emotional wellbeing

Alopecia areata can affect self-image, confidence, and mental health. It is normal to feel sad, frustrated, or worried when you notice hair loss. Do not hesitate to speak with your doctor about emotional support. Many people find that counselling, support groups, or simply talking to trusted friends and family members helps them cope.

Prevention

There is no known way to prevent alopecia areata, because it is an autoimmune condition. You cannot stop your immune system from attacking hair follicles simply by changing your lifestyle. However, reducing stress and maintaining general health may help some people avoid episodes.

Complications

If left untreated

• Hair loss can become more extensive, sometimes affecting the whole scalp or body.
• In rare cases, hair regrowth may not happen, leading to permanent hair loss.
• Leaving the condition untreated can also lead to psychological distress, low self-esteem, and depression.
• Affected skin may get sunburned if not protected.

Long-term outlook

The outlook is highly variable and honest to say you cannot predict exactly what will happen. Many people with alopecia areata see their hair regrow within a year, and even those with more widespread hair loss often improve over time. The condition is not painful or dangerous, and it does not affect your overall health. Even if hair loss persists, you can live a full, active life, and there are many options to enhance appearance and support your wellbeing.

Find support

International organisations

• National Alopecia Areata Foundation ↗
• Alopecia UK ↗

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