Alopecia areata

Overview

Alopecia areata is a condition where the body's immune system mistakenly attacks hair follicles, causing hair to fall out in small, round patches. It is not contagious and does not cause pain or serious health problems.

Alopecia areata is fairly common. It affects about 1 in 1,000 people worldwide at some point in their lives.

It can affect people of all ages, genders, and ethnicities. Most people develop it before age 30, but it can start at any age.

Symptoms

Common symptoms

• Small, smooth, round patches of hair loss on the scalp, beard, eyebrows, or other body hair.
• Hair loss that may happen suddenly over a few days or weeks.
• Tingling or mild itching in the area before hair falls out.
• Nail changes, like small dents or ridges, in some people.

Symptoms in children

• Hair loss may be more patchy and scattered on the scalp.
• Children might not notice or be bothered by the hair loss at first.
• Nail changes (like pitting) are more common in children than adults.

Symptoms in older adults

• Hair loss may be less noticeable because of age-related thinning.
• Older adults may also have other health conditions that complicate treatment.
• The condition can be emotionally distressing, especially if it affects visible areas like the eyebrows.

Causes

Main causes

• An autoimmune reaction – the immune system attacks the hair follicles by mistake.
• Genetics – it often runs in families.
• Environmental triggers like stress, illness, or injury, but these are not fully understood.

Risk factors

• Having a family history of alopecia areata or other autoimmune diseases (like thyroid disease or vitiligo).
• Having other autoimmune conditions, such as eczema, asthma, or allergies.
• Being under severe physical or emotional stress may trigger an episode in some people.

When to see a doctor

See a doctor urgently if:

• If hair loss happens very quickly over a large area, especially in children, see a doctor within a few days.
• If you have pain, redness, or signs of infection in the hair loss area.

Book a routine appointment if:

• If you notice a small patch of hair loss that does not go away after a few months.
• If the hair loss is causing you emotional distress, talk to your general practitioner.

Diagnosis

A doctor usually diagnoses alopecia areata by looking at the hair loss pattern and asking about your medical history. They may gently pull on a few hairs to see if they come out easily.

Tests that may be done

• A scalp examination under a special light (dermoscopy) to look at the hair follicles closely.
• A small skin biopsy (taking a tiny sample of scalp skin) if the diagnosis is uncertain.
• Blood tests to check for other autoimmune conditions or thyroid problems, if needed.

What to expect at your appointment

The doctor will ask about your symptoms, family history, and any recent stress or illness. The exam is painless. If a biopsy is done, the area is numbed with local anaesthetic. Results may be available in a few days to a week.

Treatment

There is no cure for alopecia areata, but many treatments can help stimulate hair growth or manage the condition. The choice depends on the extent of hair loss, your age, and your preferences.

Self-care at home

• Use a gentle shampoo and conditioner to keep your scalp healthy.
• Protect your scalp from the sun with sunscreen or a hat.
• Consider using wigs, scarves, or other coverings if you feel self-conscious.
• Avoid tight hairstyles that can pull on hair and worsen loss.
• Manage stress through relaxation techniques like deep breathing or gentle exercise.

Medical treatments

Doctors may prescribe topical medications (applied to the skin) to reduce inflammation, such as corticosteroids or other anti-inflammatory agents. For more extensive hair loss, treatments may include injections into the scalp, light therapy, or oral medications that modulate the immune system. All treatments have potential side effects; your doctor will discuss the best option for you. Do not use any treatments without a prescription.

When is surgery considered?

Surgery is not typically used for alopecia areata because the condition often recurs. Hair transplant surgery is rarely recommended.

Living with this condition

Alopecia areata does not affect your overall health, but it can be emotionally challenging. You may need to adjust your daily routine to manage hair loss, such as using eyebrow pencils or wigs if you choose.

Lifestyle tips

• Be gentle with your hair – avoid harsh chemicals, heat styling, or tight ponytails.
• Protect skin not covered by hair from sun and cold.
• Consider joining a support group to connect with others who understand.

Diet and exercise

No specific diet is proven to treat alopecia areata, but eating a balanced diet rich in vitamins and minerals supports overall health. Regular exercise can help manage stress, which may reduce flare-ups.

Mental health and emotional wellbeing

Hair loss can affect self-esteem and body image. It is normal to feel upset, anxious, or depressed. Talking to a counsellor or mental health professional can help. If you have thoughts of harming yourself, contact a crisis helpline immediately.

Prevention

There is no known way to prevent alopecia areata because it is an autoimmune condition. However, managing stress and staying healthy may help reduce the chances of a flare.

Complications

If left untreated

• Hair loss may spread to larger areas of the scalp or body (alopecia totalis or universalis).
• Nail changes may become permanent in some people.
• Emotional distress, including anxiety or depression.

Long-term outlook

The outlook for alopecia areata is generally favourable. Many people have hair that grows back on its own within a year, even without treatment. However, some may have repeated episodes of hair loss. Treatments can help, and new therapies are being developed. Even if hair loss is permanent, many people adapt well with support and coverings.

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