Alopecia Areata (AA)

What is alopecia areata?

Alopecia areata is a form of alopecia (hair loss). It’s a non life-threatening disease of your immune system affecting the hair on your scalp. With this condition, your body mistakenly views your hair follicles as an enemy. Your body attacks the hair follicles, which causes some or all of your hair to fall out, usually beginning with the hair on your head. There are three severe forms of alopecia, including areata (patchy hair loss on your head), totalis (complete hair loss on your head), and universalis (the loss of all body hair). Alopecia is not contagious. It occurs in men, women, and children of all ages. However, it is more common in children and adults in their early 20s.

Symptoms of alopecia areata

The main symptom of alopecia areata is hair loss that occurs in patches on your head, leaving smooth, round areas of scalp exposed. A mild case of alopecia areata starts with one to two smooth, hairless patches and usually stops after that. Sometimes, the hair will grow back. However, there’s no guarantee. The condition is unpredictable and the cycle of hair loss and regrowth can repeat itself. Alopecia areata can grow into another form. In its worse form, alopecia universalis causes you to lose all body hair (eyebrows, eyelashes, arms, legs, underarms, pubic, and chest and back hair for men). On rare occasions, people who have alopecia may experience burning or itching in the areas where they once had hair.

What causes alopecia areata?

There is no known cause for alopecia areata. However, scientists believe the cause of the disease may be related to a person’s genetics. In that case, scientists believe a virus or your environment cause the hair loss.

How is alopecia areata diagnosed?

See your doctor if you are experiencing hair loss of any significant amount. There are many reasons for hair loss. Your doctor will look at your hair loss pattern and review your medical history when diagnosing alopecia areata. He or she will check to see if the hairless areas of your scalp are smooth and peach-colored (which is a sign of the condition), or if your scalp is scarred and scabbed. Your doctor may pull a couple of hairs from your head to examine. Sometimes, the remaining hair in alopecia areata has a specific shape. If your doctor can’t confirm a diagnosis, he may send you to a lab for a blood test. They will scrape a small sample of skin from your scalp to rule out another disease or condition that causes hair loss.

Can alopecia areata be prevented or avoided?

The condition cannot be prevented or avoided. The cause is unknown and varies by person. Alopecia areata is not tied to stress, as some people believe. Some people have a family history of alopecia areata. Having a family member with alopecia areata and another immune system diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, lupus, vitamin B12 anemia, Addison’s disease, and atopic dermatitis (a dry, itchy skin condition also called atopic eczema) can raise your risk of having alopecia areata. However, it is rare for a parent to pass the condition onto a child. People who do not have another immune system disease and have alopecia areata commonly have thyroid disease, nasal allergies, and asthma.

Alopecia areata treatment

There is no treatment that offers a 100% cure for alopecia areata. If you have a few, small patches of hair loss on your head, it’s likely your hair will grow back within a few months. Your doctor may not prescribe treatment in those cases. For larger areas of hair loss, your doctor may prescribe multiple steroid injections (once every two to six weeks) under your scalp to attempt to regrow your hair. Other treatments include hair growth medicines that contain steroids that you apply to your skin, or ultraviolet light therapy. Contact immunotherapy is another therapy. It purposely causes an allergic reaction on your scalp that could trigger hair growth. With this treatment, the medicine that is applied to your scalp irritates your skin, making it red and scaly. It could take as long as three months to see hair growth if this treatment works. Contact immunotherapy does have side effects, including a severe rash and swollen lymph nodes in your neck. No matter what therapy you try, hair loss usually returns when you stop treatment.

Living with alopecia areata

The Orenschools (AAFP) recognizes that living with alopecia areata can be emotionally difficult. It affects social interaction and self-confidence, as people are embarrassed to let others see their hair loss.

Hairstyling techniques or hair care products can help to cover up the loss. However, some hair care products can be harsh on your hair and cause additional damage and loss. You might want to talk with your doctor about what products to avoid. People who have alopecia areata are encouraged to be creative with hats, scarves, and wigs.

Losing your eyelashes, eyebrows, and the hair in your nose and ear also is a problem. Hair protects your eyes, nose, and ears from the irritation of dust, germs, and small, foreign particles. Cover areas of exposed scalp with a hat or sunscreen to reduce your risk of sunburn and skin cancer.

Questions to ask your doctor

  • How much hair do I need to lose before calling my doctor?
  • If one of my parents has alopecia areata, is there a genetics test I can take to determine if I will get it?
  • If my hair loss has lasted more than a year, what are the chances it will return?
  • Do certain diseases put people at risk for developing alopecia areata?