What is alopecia areata?
Finding a bald patch on your head is a shock. It often appears in a few days, and it may be a hairdresser, partner or parent who spots it first. The first questions are always the same: will it spread, and will it grow back?
In alopecia areata, the immune system mistakenly targets the hair follicles and pushes them into a resting state. The follicles stay alive, which is why the hair can regrow, sometimes on its own. It affects around 2 in every 100 people at some point in their lives, at any age, and most often starts before the age of 30.
Not every bald patch is alopecia areata. Ringworm, hair pulling, tight hairstyles and scarring conditions can look similar, so it’s worth having it diagnosed. Types and causes of hair loss.
The short answer
Alopecia areata is an autoimmune condition that causes smooth, round patches of hair loss, usually on the scalp. The immune system attacks the hair follicles, but doesn’t destroy them, so the hair can grow back. In about half of people, it regrows within a year. It isn’t catching and it isn’t your fault.
Signs of alopecia areata
- One or more smooth, round bald patches that appear suddenly
- Skin in the patch that looks normal, or slightly pink
- Short, broken hairs at the edge of a patch that narrow towards the root, called exclamation mark hairs
- Tingling, itching or tenderness before the hair falls, in some people
- Patches in the beard, eyebrows or eyelashes
- Fine white hairs growing back first, which usually darken in time
A patch that is scaly, red, sore or crusty is less likely to be alopecia areata. In children especially, scaly patches with broken hairs can be scalp ringworm, a fungal infection that needs treatment from a GP.
Irregular patches with broken hairs of different lengths can be trichotillomania, and thinning along the hairline from tight styles is traction alopecia.
Types of alopecia areata
It doesn’t look the same in everyone. These are the patterns I see.
Patchy alopecia areata
One or more round or oval bald patches, often the size of a coin. This is by far the most common type.
Ophiasis
Hair loss in a band around the sides and back of the head, along the hairline. It can be slower to regrow.
Alopecia areata incognita
Sudden thinning all over the scalp rather than patches. It looks like shedding, so it’s easily missed.
Beard and eyebrows
Alopecia areata can cause round patches in the beard, called alopecia barbae, and loss of eyebrows or eyelashes.
Alopecia totalis and universalis
Loss of all the hair on the scalp, or on the whole body. This is uncommon. Alopecia totalis and universalis.
Nail changes
Some people have small pits or ridges in their fingernails, which can be a clue to the diagnosis.
What causes alopecia areata?
Alopecia areata is an autoimmune condition, and the exact reason the immune system turns on the follicles isn’t fully understood. Your genes play a part: it’s more common if a relative has it, and in people with other autoimmune conditions such as thyroid disease or vitiligo, or with eczema, asthma or hay fever.
Some people notice it after a stressful time, an illness, an operation or having a baby. But many have no trigger at all, and it isn’t caused by anything you did or didn’t do. It isn’t caused by hair products, hats or washing, and you can’t catch it from anyone.
Because it’s linked with thyroid problems, a blood test is sometimes worthwhile. Thyroid hair loss.
Does hair grow back after alopecia areata?
Very often, yes. The follicles aren’t destroyed, so the hair can regrow at any time, even after months or years. In about half of people with a few small patches, the hair grows back within a year without treatment.
- Regrowth is often white or fine at first, then thickens and returns to its natural colour.
- It can come back. Many people have more than one episode over their life, sometimes years apart.
- Some patterns are slower: widespread loss, ophiasis, starting in childhood and loss lasting more than a year are less likely to regrow on their own.
It’s unpredictable, which is one of the hardest things about it. Check-ups help me see whether patches are active or regrowing, and support you further.
Alopecia areata in children
Alopecia areata is one of the most common causes of patchy hair loss in children. Parents often find a patch while brushing their child’s hair, or a school nurse or hairdresser spots it.
- Have any new bald patch in a child checked by your GP first, to rule out ringworm, which needs antifungal medicine.
- Let your child have a say in what is shared with teachers, friends and relatives. Some are happy to talk about it; others prefer privacy.
- Try not to check their hair constantly. Calm, age-appropriate conversations help more than close watching.
- Children who start young are more likely to have it return, so it helps to know what to expect.
I see children and teenagers with a parent, at a pace that suits them. Children’s hair loss.
Alopecia areata treatment
There’s no cure, and no treatment works for everyone, but several can help hair regrow. The right choice depends on how much hair is affected, how long it’s been, your age and how you feel about it.
Waiting and watching
For a few small patches, regrowth often happens on its own. Many people choose to wait, with check-ups along the way.
Steroid injections
Small injections of steroid into the patches can help regrowth in adults. They’re given by a dermatologist or a specially trained doctor.
Steroid creams and lotions
A strong steroid cream, lotion or foam from your GP or dermatologist may help, especially in children.
Specialist treatments
For more widespread loss, a dermatologist may offer contact immunotherapy or light therapy.
JAK inhibitor tablets
For severe alopecia areata in people aged 12 and over, the NHS can offer a newer tablet called ritlecitinib, through a dermatologist.
Wigs, toppers and brows
A wig, topper or eyebrow treatment can make a real difference to how you feel while you wait for regrowth, or if it doesn’t come.
Be wary of supplements, oils and products that promise to cure alopecia areata. None is proven, and they can be expensive.
How I can help
At a consultation in Forest Row we spend about an hour together. It’s calm, unhurried and confidential.
- A full history: when the patches appeared, any earlier episodes, your health, family history and how you’re coping
- A close examination of your hair and scalp, looking for signs of activity and regrowth
- Ruling out conditions that look similar, including shedding, ringworm, hair pulling and scarring hair loss
- A letter to your GP or dermatologist if treatment or tests are needed
You leave knowing what you have, what to expect and what your options are, with a written plan for looking after your scalp and hair. Please bring photos of how the patches have changed, a list of medicines and supplements, and any recent test results. What happens at a consultation.
When to see your GP first
Please see your GP or call NHS 111 if:
- your hair loss came on suddenly and you feel unwell
- your scalp is very painful, swollen, weeping or bleeding
- you have patches of hair loss with redness or scarring that are spreading quickly
- you think a new medicine may be the cause. Don’t stop it without speaking to your doctor
You can still see me as well. I’ll happily liaise with your GP if further tests are needed.
Questions about alopecia areata
If yours isn’t here, send me a message and I’ll get back to you.
Is alopecia areata contagious?
No. It’s an autoimmune condition, not an infection, so you can’t catch it or pass it on.
Is alopecia areata permanent?
Usually not. The follicles aren’t destroyed, so hair can regrow, and in about half of people with a few patches it does within a year. Widespread or long-lasting loss is less likely to regrow on its own.
Can stress cause alopecia areata?
Stress may trigger an episode in some people, but many have no trigger at all. It isn’t caused by something you did, and worrying about it doesn’t mean you caused it.
Will the patches spread?
They may. Some people have one patch that regrows; others get new patches over weeks or months. It’s impossible to predict, which is why check-ups help.
Can alopecia areata affect the beard?
Yes. Round patches in the beard are called alopecia barbae. They often regrow, and can be treated in the same way as scalp patches.
Why is my hair growing back white?
New hairs often grow back white or fine at first, because the pigment cells recover more slowly. They usually darken over the following months.
Can alopecia areata start after having a baby?
Yes. Childbirth can be a trigger. Smooth bald patches aren’t part of normal postpartum shedding, so get them checked. Postpartum hair loss.
Let’s find out what’s going on
Book online at a time that suits you. If you have a question first, send me a message.