Alopecia Areata Symptoms Treatments

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Patient information from the BMJ Group

Alopecia areata

Alopecia areata

Alopecia areata is an illness that causes patches of hair to fall out. But it doesntdestroy the hair follicle, so there is always the chance for regrowth, which oftenoccurs.

We've brought together the research about alopecia areata and talked to expertsabout the best way to treat it. You can use our information to talk to your doctorand decide which treatments are best for you.

What is alopecia areata?

'Alopecia' is a general term doctors use when talking about hair loss. Alopecia areata(pronounced al-oh-PEE-shah air-ee-AH-tah) is a type of hair loss that's thought to becaused by an autoimmune disease.

If you have an autoimmune disease, the cells in your body that normally fight infection(white blood cells) attack some of your own cells by mistake. In alopecia areata, theygather around hair follicles, causing inflammation that makes your hair stop growing andfall out.

Fortunately, your hair follicles aren't permanently damaged, so your hair can grow back.Most people have one or a few patches of hair loss on their scalp, but some lose a

significant amount of their hair. Less commonly, people lose all the hair on their scalp(called alopecia totalis) or all the hair on their body (alopecia universalis).

Alopecia areata affects people of all backgrounds and ages. Often an individual who hasalopecia areata may have more than one episode of hair loss. Many get it first as a childor young adult.

Doctors don't know why some people get alopecia areata and others don't. However,around 2 in 10 people with alopecia areata have a family member who also has it.Youmay also be more likely to get it if you or someone in your family has another type of

autoimmune disease, such as type 1 diabetes, thyroid disease, or vitiligo (white patcheson the skin).

What are the symptoms?

Most people get patches of hair loss over a few weeks.The patches are usually coin-sizedand round or oval. The scalp without hair is smooth and looks normal (it's not red orinflamed). Some people say they have tingling or very minor pain in the affected area.

You may have short hairs (around 3 millimetres long) at the edges of these patches.Doctors call these exclamation mark hairs.

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Alopecia areata can also affect any part of your body that has hair, including youreyebrows, eyelashes, beard, armpits, and genitals. Some people also get nail pitting.This is when your nails appear rough or slightly dented.

What treatments work?

There is no cure for alopecia areata, but treatments can help the hair to grow back.However, many people have regrowth without any treatment.

Weve described some of the common treatments below, with information about howlikely they are to work. You can use this information to talk to your doctor about yourtreatment options.

Mild hair loss

If you have just a couple of small patches of hair loss, there's a good chance the hair willregrow on its own. Around 4 out of 5 people with small patches have full regrowth in a

year or less.The regrowth usually starts after three months or so. Until your hair regrows,you may be able to hide your hair loss by trying a different hairstyle.

Mild to moderate hair loss

If you have more than a couple of patches of hair loss, your doctor may suggest usingsteroid injections or medicines you put on your skin.

Steroid injections are the best treatment for areas of patchy hair loss, with regrowthusually starting in one to two months. However, they don't work for everyone, and theyaren't usually used for children.

Steroids are drugs that reduce inflammation.They can be injected directly into any areawith hair loss, including your scalp and eyebrows, although they're less likely to be usedon your beard.You will probably see a specialist for this treatment.The doctor may firstnumb your skin by putting a painkilling cream on it (a topical anaesthetic). Dependingon the size of the area being treated, you may need several injections.

You may also require more than one treatment.These are spaced at a minimum of sixweeks apart. Injections can sometimes causes thinning of the skin (called mild indentation)but this is usually temporary. Pimples and redness at the site of the injections are other

possible side effects.Steroids also come as gels, liquids, creams, and lotions that you put directly on areas ofhair loss. Doctors call these topical steroids. What type you use will depend on whereyour hair loss is (liquids and gels, for example, may be easier to apply to your scalp).Topical steroids may be used in children.

Minoxidil is a treatment many men use to regrow hair if they are balding. It usually comesas a liquid. New hair may start growing in about 12 weeks, although this treatment doesn'tproduce significant regrowth for everyone.You may get some skin irritation when usingminoxidil. Sometimes minoxidil treatment and topical steroids may be used together.


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If a treatment hasn't worked after six months, your doctor will probably recommend tryinga different one.

Widespread hair loss

If your hair loss is severe, steroid injections and medicines you put on your skin are less

likely to work. But there are other treatments you can try.

Topical immunotherapy (also called contact sensitisation treatment) involves makingyou allergic to a substance and then regularly applying a weak version of it to keep yourskin mildly irritated (inflamed).This stimulates hair growth for up to 6 in 10 people, althoughresearchers don't know exactly why. This treatment can have side effects, includingblistering, itching, and enlarged glands in your neck. If you have darker skin, your skincolour may lighten in the areas being treated.

People with widespread hair loss also sometimes take steroid tablets. But these cancause many side effects, including high blood pressure, worsening of blood sugar control

in people with diabetes, increased appetite, and stomach irritation (gastritis).

Coping with hair loss

Understandably, many people have a hard time dealing with their hair loss. It can beespecially devastating for children and teenagers, who may already be struggling withtheir self-esteem. Be sure to tell your doctor if you're having difficulty coping or feelingdepressed.Your doctor can provide support, and may recommend talking to a counselloror attending a support group. Meeting other people with alopecia areata can be a hugehelp.

People often wear wigs, hats, and other coverings to disguise their hair loss. Many men(and some women) opt to shave their head until their hair starts to regrow. But if yourscalp is uncovered, make sure you wear sunscreen to prevent sun damage.

Make-up and temporary tattoos are options for hiding lost eyebrows.

What will happen to me?

If your hair loss is mild, you have a very good chance of full regrowth. Your hair may bewhite or fine when it first grows in, but it should return to its normal colour and texture.

If your hair loss is more widespread, you may still have full regrowth, although this is lesslikely. Most people with alopecia areata have more than one episode of hair loss in theirlifetime.

Up to 1 in 10 people get severe, ongoing alopecia areata. But no matter how severe yourhair loss, you still have the potential to regrow hair, since your hair follicle is notpermanently damaged. Some people even regrow hair after many years, although thelonger you have no regrowth, or the more severe your hair loss, the less likely it is thatyour hair will grow back. But remember: alopecia areata is an unpredictable illness, andno one can say for sure how it will affect you.


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This information is aimed at a UK patient audience. This information however does not replace medical advice.

If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content.For more information about this condition and sources of the information contained in this leaflet please visit the Best

Health website, http://besthealth.bmj.com . These leaflets are reviewed annually.

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