UNDERSTAND YOUR SKIN
Alopecia Areata
What is alopecia areata?
Alopecia areata is a condition in which clearly defined patches of hair loss appear. It most commonly affects the scalp, but can also affect the eyebrows, eyelashes, beard or other hair-bearing parts of the body. Hair loss usually begins suddenly and manifests as round or oval, smooth patches.
Alopecia areata can occur in children and young people as well as in adults. In some people, it affects only a small area and the hair regrows spontaneously, whilst in others the hair loss is more extensive or tends to recur.
The condition often causes significant emotional distress, particularly when it affects visible areas such as the scalp, face or eyebrows. However, it is important to know that alopecia areata is not the result of poor hygiene and does not mean that the hair follicles have been permanently destroyed. Modern dermatology offers treatments that can suppress the inflammatory process and aid hair regrowth in suitable patients.
Main signs and symptoms
Usually, the affected skin remains smooth and scar-free. This is an important characteristic because, in alopecia areata, the follicles are not usually permanently destroyed. For this reason, it is possible for the hair to grow back.
Hair loss may begin with a single small round patch, but sometimes several patches appear within a relatively short period of time. In some patients, the hair begins to grow back, whilst in others new bald patches appear.
Characteristic short hairs are sometimes observed on the affected skin; these are thinner at the base or resemble an exclamation mark. There may also be changes to the nails, such as small indentations, longitudinal ridges or changes to the surface.
Types and patterns
Alopecia areata can vary in severity and extent.
Alopecia areata in patches – the most common form, in which one or more localised areas of hair loss appear.
Alopecia totalis – characterised by almost or completely total hair loss on the scalp.
Alopecia universalis – a rarer and more severe form, in which almost all body hair may be affected, including eyebrows, eyelashes and the beard.
Ophiasis type – hair loss is mainly located around the periphery of the scalp, particularly in the occipital and temporal regions.
There are also variants in which the condition primarily affects the eyebrows, eyelashes or beard. The severity of the condition is not determined solely by the size of the first patch, as in some people limited hair loss may subsequently progress.
Why does it develop?
Alopecia areata is an autoimmune condition that affects the hair follicles. In this condition, the immune system mistakenly attacks structures around the follicle, triggering an inflammatory reaction that disrupts the normal hair growth cycle.
Causes and risk factors
The exact reason why the immune system begins to attack the hair follicles is not yet fully understood. It is thought that the condition arises as a result of a combination of genetic predisposition and environmental factors.
Factors that may play a role include:
- a family history of the condition;
- other autoimmune diseases;
- certain genetic characteristics;
- infectious or other factors that may affect the immune system;
- physical or emotional stress in some patients.
It is important to clarify the issue of stress. It is often cited as a cause of alopecia areata, but it cannot be claimed that stress in itself causes the condition. In some people, severe stress or other physical strain may precede its onset or exacerbation, but the mechanism is much more complex.
Alopecia areata is not contagious. It cannot be transmitted through contact, the sharing of personal items, or proximity to someone who has the condition.
Is it a medical condition?
Yes. Alopecia areata is a chronic autoimmune condition that can occur in episodes – with active hair loss followed by regrowth.
This does not necessarily mean that the condition will persist indefinitely. In many people, hair regrowth occurs, particularly when the condition is localised. In others, there may be recurrent episodes.
Alopecia areata does not lead to scarring in typical cases. This distinguishes it from scarring alopecias, in which inflammation can destroy the hair follicle and lead to permanent hair loss.
In some patients, alopecia areata occurs alongside other autoimmune conditions. This does not mean that everyone with alopecia areata has another condition, but if certain symptoms are present, the doctor may decide whether further investigations are necessary.
Everyday care
Home care cannot cure the autoimmune process, but it is important for protecting the scalp and hair.
Where there are patches of exposed skin, these are more susceptible to sunburn. It is therefore important to protect them with a suitable sunscreen or physical protection, such as a hat, when out in the sun.
It is also recommended that you:
- use gentle shampoos;
- avoid vigorous brushing;
- do not pull the hair tight with very tight hairstyles;
- limit the frequent use of high heat;
- avoid harsh chemical treatments on an irritated scalp;
- maintain a balanced diet.
There is no need for a person with alopecia areata to use special ‘stimulating’ shampoos unless there is a specific medical reason. Hair loss in this condition stems from an immune reaction around the follicle, not from insufficient cleansing of the scalp.
Popular home remedies: benefits and limitations
There is no proven home remedy that can eliminate the autoimmune cause of alopecia areata. Oils, onions, garlic, various herbal mixtures and other popular remedies have not been proven to treat the condition.
Some of these remedies may even irritate the scalp and cause contact dermatitis. This can further complicate the condition and make it more difficult to monitor.
A more sensible approach is for home care to focus on protecting the scalp and being gentle on the hair, whilst medical treatment controls the underlying process. A balanced diet is also important, but taking iron, zinc, biotin or other supplements should not be started without a confirmed deficiency or a doctor’s recommendation.
When should you see a doctor?
If clearly defined bald patches appear suddenly, it is advisable to consult a dermatologist. Not every type of hair loss is alopecia areata, and an accurate diagnosis is important for choosing the right treatment.
A consultation is particularly recommended if:
- new patches appear within a short period of time;
- the patches are gradually getting larger;
- the eyebrows, eyelashes or beard are affected;
- there are changes to the nails;
- the hair loss is extensive;
- there is redness, flaking, pain or itching;
- hair loss is diffuse across the entire scalp;
- there is evidence of scarring or changes in skin structure.
During the examination, the dermatologist may use dermatoscopy to assess the hair follicles and the characteristic changes associated with the condition. If the presentation is atypical, further investigations may be required, including blood tests or, in certain cases, a skin biopsy.
Modern treatment options
Treatment is determined by age, the extent of hair loss, the duration of the condition and whether the process is active.
For limited alopecia areata, topical corticosteroids are often used to suppress inflammation around the hair follicles. In suitable patients, corticosteroids may also be administered by injection into the affected areas.
Minoxidil is sometimes used as an adjunctive therapy to promote hair growth, but it does not suppress the underlying autoimmune mechanism and is not suitable as the sole treatment for all forms of the condition.
Systemic therapies may be used in cases of more extensive alopecia. In recent years, JAK inhibitors have become particularly important; these are targeted medicines that act on specific signalling pathways in the immune system. They may be effective in some patients with severe alopecia areata, but they have specific indications, contraindications and potential adverse reactions, and must be prescribed by a doctor.
Depending on the individual case, other approaches may also be considered, including topical immunotherapy for certain severe forms.
It is important to note that hair regrowth is not always rapid. Even when treatment suppresses the activity of the condition, the hair follicle needs time to go through the necessary growth phases again.
Read the clinical guidance on this concern. Treatment suitability, risks and availability should be discussed during consultation. Find your Skin Line clinic for assessment and personalised advice.