Harvard Health A-Z

Alopecia Areata

What Is It?

Alopecia areata is a skin disorder that causes hair loss, usually in patches, most often on the scalp. Usually, the bald patches appear suddenly and affect only a limited area. The hair grows back within 12 months or less. For some people, however, the problem can last longer and be more severe, producing total baldness (alopecia totalis) or total loss of body hair (alopecia universalis).

The cause of alopecia areata is probably an autoimmune reaction. This means the body's immune system incorrectly targets and attacks the body's own cells. In the case of alopecia areata, the cells under attack are those of the hair follicles (structures that grow hair), especially follicles within the scalp.

Genetic (inherited) factors may play a role, too, particularly when the disorder strikes those under age 30. Almost 40% of people under 30 with alopecia areata have at least one family member who has been diagnosed with the same disorder.

The risk of developing alopecia areata is unusually high in people who suffer from asthma, hay fever, thyroid disease, vitiligo (a condition in which patches of skin lose their color), pernicious anemia and Down syndrome.

Although experts once believed episodes of alopecia areata could be triggered by stress, newer research has failed to prove that stress is a factor.

Approximately 1% to 2% of people in the United States develop alopecia areata at some time during their lives. In about 60% of cases, the first episode of hair loss occurs before age 20 and is followed by hair regrowth. Unfortunately, it?s common for the problem to come back, and new bald patches can develop at the same time older ones are regrowing hair.

Symptoms

In its most common form, alopecia areata produces small round or oval patches of baldness on the scalp. The area of bald skin looks smooth and normal. In most cases, there are no other scalp symptoms. Occasionally, there is mild itching, tingling, tenderness or a burning sensation in the affected area. Some people with alopecia areata also have abnormalities in the surface of their fingernails, such as tiny pits or dents, grooves, superficial splitting or an abnormal area of redness.

In rarer, more severe forms of the disorder, hair loss can involve the entire scalp or the entire body, including the eyebrows, eyelashes, beard, underarm hair and pubic hair (hair around the genitals).

Diagnosis

Your doctor may suspect that you have alopecia areata based on your symptoms and, in some cases, your family history of the disorder. To look for further evidence, your doctor will examine your scalp and pull gently on the hairs near the margin of the bald area. If these hairs come out very easily, the doctor will inspect them for obvious structural abnormalities of the root or shaft. In some cases, a small skin biopsy of your scalp may confirm the diagnosis. In a biopsy, a small piece of skin is removed and examined in a laboratory.

Expected Duration

In most small patches of alopecia areata, the hair regrows within six to 12 months. However, recurrences are common.

Prevention

Alopecia areata cannot be prevented.

Treatment

Although there is no permanent cure for alopecia areata, there are ways to short-circuit the body's autoimmune reaction in the scalp and encourage hair regrowth. Options include:

• Topical (applied to the surface) cortisone cream applied onto or cortisone solution injected into the bald patches to suppress the immune reaction

• Topical immunotherapy using chemicals such as diphenylcyclopropenone (diphencyprone; DCP) or squaric acid dibutyl ester (SADBE) on the scalp that can produce an allergic reaction, which may neutralize the turned on immune cells.

• Topical minoxidil (Rogaine) can increase hair growth by accelerating the speed of the natural hair cycle. It may also increase the diameter of hairs that do begin to grow.

• Topical anthralin (Drithocreme, Dritho-Scalp, Micanol) causes a non-specific scalp irritation that may stimulate early hair re-growth. Topical anthralin and minoxidil may be used together.

• Psoralen and ultraviolet A phototherapy (controlled exposure of the affected skin to ultraviolet light)

• A short course of corticosteroids (such as prednisone) by mouth, or rarely, intravenously (through a vein) for adult patients with extensive hair loss

Your treatment depends on several factors, including your age (some treatments are only for adults), the amount of your hair loss and your willingness to deal with any treatment-related discomfort or side effects.

If you have mild hair loss, you may choose to simply modify your hairstyle or wear a hairpiece until the bald area fills in.

If you lost a large amount of hair on your scalp, you may choose to wear a wig or hairpiece until your treatment starts to work. If you have an obvious loss of eyebrow hair, you may choose to have injections of tiny dots of colored pigments into the eyebrow area (a procedure called dermatography). If coping with the change in your appearance is hard to deal with, mention it to your doctor or seek advice from a mental-health professional.

When To Call A Professional

Make an appointment to see your doctor if:

• You suddenly develop a bald spot on your scalp

• Your hair stylist tells you that your hair is thinning, or that you have small bald areas

• You have lost your eyebrows or eyelashes, your beard is thinning, or you have noticeably less hair on your underarms or pubic area

Prognosis

In more than 90% of cases, hair grows back and fills the bald spot within one year, even without treatment. However, recurrences are common, and most people have several episodes of the disorder during a lifetime. Only about 7 % of people develop severe, long-term forms of the illness that produce large areas of hair loss with little hair regrowth.

Additional Info

National Institutes of Health (NIH)

9000 Rockville Pike

Bethesda, MD 20892

Phone: (301) 496-4000

http://www.nih.gov

American Academy of Dermatology

930 E. Woodfield Rd.

Shaumburg, IL 60173-4927

Phone: (847) 330-0230

Toll-free: (888) 462-3376

http://www.aad.org

National Alopecia Areata Foundation

710 C St., Suite 11

San Rafael, CA 94901

Phone: (415) 456-4644

Fax: (415) 456-4274

http://www.naaf.org/

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