Alopecia Areata


What is Alopecia Areata?

Alopecia areata is a prevalent autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis).

Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head. The scalp is the most commonly affected area, but the beard or any hair-bearing site can be affected alone or together with the scalp. If limited only to the beard, it is called alopecia areata barbae.

In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called "exclamation point" hair). Ophiasis refers to hair loss in the shape of a wave at the circumference of the head. Alopecia areata totalis and universalis are rare.

  

Who Gets Alopecia Areata?

Anyone can have alopecia areata. It often begins in childhood. There is a slightly increased risk of having the disease if you have a close family member with the disease. Alopecia areata is not contagious.

Alopecia areata occurs in males and females of all ages, but onset often occurs in childhood. The condition affects 0.1%–0.2% of the population. Over 6.6 million people in the United States and 147 million worldwide have, had or will develop alopecia areata at some point in their lives.

What Causes Alopecia Areata?

Alopecia areata is an autoimmune disease. Normally the immune system protects the body against infection and disease. In an autoimmune disease, the body’s immune system mistakenly attacks some part of your own body. In alopecia areata, the immune system attacks the hair follicles.

The cause is not known. Scientists think that a person’s genes may play a role. For people whose genes put them at risk for the disease, some type of trigger starts the attack on the hair follicles. The triggers may be a virus or something in the person’s environment.

In 2010, a genome-wide association study was completed that identified 129 single nucleotide polymorphisms that were associated with alopecia areata. The genes that were identified include those involved in controlling the activation and proliferation of regulatory T cells, cytotoxic T lymphocyte-associated antigen 4, interleukin-2, interleukin-2 receptor A, and Eos (also known as Ikaros family zinc finger 4), as well as the human leukocyte antigen. The study also identified two genes, PRDX5 and STX17, that are expressed in the hair follicle.

How is alopecia areata diagnosed?

Alopecia areata is diagnosed through a medical history and physical examination. Your doctor will ask you questions about your hair loss, look at the pattern of your hair loss, and examine your scalp. And he or she may tug gently on a few hairs or pull some out.

If the reason for your hair loss is not clear, your doctor may do tests to check for a disease that could be causing your hair loss. Tests include:


Trichoscopy image of alopecia areata
  • Hair analysis. Your doctor will take a sample of your hair and examine it under a microscope.
  • A scalp sample is also sometimes taken
  • In trichoscopy hair and scalp structures may be visualized at many-fold magnification. Currently magnifications ranging from 10-fold to 70-fold are most popular in research and clinical practice
  • Blood tests, including testing for a specific condition, such as an overactive or underactive thyroid gland (hyperthyroidism or hypothyroidism)

How Is Alopecia Areata Treated?

Because hair usually grows back within a year, you may decide not to treat alopecia areata. There is no cure for alopecia areata. Doctors may use medicines approved for other diseases to help hair grow back.

The most common treatment for patchy hair loss is many injections of corticosteroids into the scalp, about 1 cm (0.4 in.) apart, every 4 to 6 weeks.

Children and some adults may be treated with topical corticosteroids that are applied to the affected skin.

Minoxidil (Rogaine) may be used along with topical corticosteroids.

Contact immunotherapy triggers an allergic reaction on the scalp that may help hair to grow. A medicine is "painted" on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of beginning treatment. Side effects of contact immunotherapy include a severe rash (contact dermatitis) and swollen lymph nodes, especially in the neck.

Psoralen with ultraviolet A light (PUVA) therapy may also be used to treat alopecia areata. PUVA usually is reserved for people who have large areas of skin affected by the disorder or who cannot use other treatments. For PUVA, a medicine called a psoralen is used to make the skin more sensitive to ultraviolet A (UVA) light. Then the skin is exposed to UVA light.

However, none of these treatments prevent new patches of hair loss or cure the disease. Talk to your doctor about the treatment that is best for you.

Will My Hair Ever Grow Back?

Alopecia areata is a highly unpredictable and cyclical condition. The affected hair follicles become very small and produce no visible hair above the skin’s surface. Hair can grow back in or fall out again at any time, and the disease course is different for each person. The hair usually grows back in a few months, and although the new hair is usually the same color and texture as the rest of the hair, it sometimes is fine and white. No matter how widespread the hair loss, most hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years.

About 10% of people with this condition may never regrow hair. You are more likely to have permanent hair loss if you:

  • Have a family history of the condition
  • Have the condition at a young age (before puberty) or for longer than 1 year
  • Have another autoimmune disease
  • Are prone to allergies (atopy)
  • Have extensive hair loss
  • Have abnormal color, shape, texture, or thickness of the fingernails or toenails. In some people with alopecia areata, the fingernails and toenails become pitted and look as if a pin had made many tiny dents in them. They may also look like sandpaper. This is called Trachyonychia.
     

How Will Alopecia Areata Affect My Life?

Alopecia areata does not make you feel pain and does not make you feel sick. You can’t give it to others. People who have the disease are, for the most part, healthy in other ways. Alopecia areata will not shorten your life, and it should not affect activities such as going to school, working, marrying, raising a family, playing sports, and exercising.

How Can I Cope With the Effects of This Disease

Living with hair loss can be hard. There are many things you can do to cope with the effects of this disease, including:

  • Learning as much as you can about the disease.
  • Talking with others who are dealing with the disease.
  • Learning to value yourself for who you are, not for how much hair you have or don’t have.
  • Talking with a counselor, if necessary, to help build a positive self-image.

Here are some things you can use to reduce the physical dangers or discomforts of lost hair:

  • Use sunscreens for the scalp, face, and all exposed skin.
  • Wear eyeglasses (or sunglasses) to protect eyes from sun, and from dust and debris, when eyebrows or eyelashes are missing.
  • Wear wigs, caps, or scarves to protect the scalp from the sun and keep the head warm.
  • Apply antibiotic ointment inside the nostrils to help keep germs out of the nose when nostril hair is missing.

Here are some things you can do to reduce the disease’s effects on your looks:

  • Try wearing a wig, hairpiece, scarf, or cap.
  • Use a hair-colored powder, cream, or crayon applied to the scalp for small patches of hair loss to make the hair loss less obvious.
  • Use an eyebrow pencil to mask missing eyebrows.
 

What Research Is Being Done on Alopecia Areata?

Researchers are seeking a better understanding of the disease. Scientists are studying:

  • Genes
  • Hair follicle development
  • Immune treatments
  • Stem cells in the skin
  • Medications.

The National Alopecia Areata Foundation (NAAF) is working on treatments. See the NAAF Website for up-to-date information.

For More Information About Alopecia Areata and Other Related Conditions:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484>br? Toll free: 877-22-NIAMS (877-226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: niams.nih.gov