Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss. It affects 2 percent of Americans (roughly 6.5 million people).
The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30.
The word "alopecia" comes from Ancient Greek and roughly translates as "fox disease," on account of foxes changing their fur twice a year. The word "areata" means "occurring in patches or circumscribed areas."
In this article, we look at the causes and symptoms of alopecia areata, its diagnosis, and potential treatments.
Fast facts on alopecia areata
Here are some key points about alopecia areata. More detail and supporting information is in the main article.
- One in five people with alopecia areata also has a family member who has experienced the condition
- Alopecia areata often develops suddenly, over the course of just a few days
- There is little scientific evidence that alopecia areata is caused by stress
- People with alopecia areata who have only a few patches of hair loss often experience a spontaneous, full recovery, without the need for treatment
- There is no cure for alopecia areata
What is alopecia areata?
Alopecia areata is a common autoimmune disorder that commonly results in unpredictable hair loss.
Alopecia areata is "a common condition of undetermined etiology characterized by circumscribed, nonscarring, usually asymmetric areas of baldness on the scalp, eyebrows, and bearded portion of the face."
In the majority of cases, hair falls out in small patches around the size of a quarter. For most people, the hair loss is nothing more than a few patches, though in some cases it can be more extreme.
Sometimes, it can lead to the complete loss of hair on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia universalis).
Alopecia areata is considered to be an autoimmune disease, where the immune system mistakenly attacks the body's own cells instead of harmful foreign invaders.
In the case of alopecia areata, the immune system attacks the hair follicles causing inflammation, which leads to hair loss.
Causes of alopecia areata
The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body's immune system to target hair follicles in this way.
While scientists are unsure why these changes occur, it seems that genetics are involved as alopecia areata is more likely to occur in a person who has a close family member with the disease. One in five people with the disease has a family member who has also developed alopecia areata.
Other research has found that many people with a family history of alopecia areata also have a personal or family history of other autoimmune disorders, such as atopy (a disorder characterized by a tendency to be "hyperallergic"), thyroiditis, and vitiligo.
Despite what many people think, there is very little scientific evidence to support the view that alopecia areata is caused by stress. Extreme cases of stress could potentially trigger the condition, but most recent research points toward a genetic cause.
Symptoms of alopecia areata
The most prominent symptom of alopecia areata is patchy hair loss. Coin-sized patches of hair begin to fall out, mainly from the scalp. Any site of hair growth may be affected, though, including the beard and eyelashes.
The loss of hair can be sudden, developing in just a few days or over a period of a few weeks. There may be itching or burning in the area prior to hair loss. The hair follicles are not destroyed and so hair can re-grow if the inflammation of the follicles subsides. People who experience just a few patches of hair loss often have a spontaneous, full recovery without any form of treatment.
About 30 percent of individuals who develop alopecia areata find that their condition either becomes more extensive or becomes a continuous cycle of hair loss and regrowth.
About half of patients recover from alopecia areata within 1 year, but many will experience more than one episode. Around 10 percent of people will go on to develop alopecia totalis or alopecia universalis.
Alopecia areata can also affect the fingernails and toenails, and sometimes these changes are the first sign that the condition is developing. There are a number of small changes that can occur to nails:
Alopecia affects both men and women equally.
- Pinpoint dents appear
- White spots and lines appear
- Nails become rough
- Nails lose their shine
- Nails become thin and split
Additional clinical signs include:
- Exclamation mark hairs - where a few short hairs that get narrower at their bottom and grow in or around the edges of bald spots
- Cadaver hairs - hairs broken before reaching the skin surface
- Regrowth of white hair in areas affected by hair loss
Tests and diagnosis of alopecia areata
Doctors are usually able to diagnose alopecia areata fairly easily by examining symptoms. They might look at the degree of hair loss and examine hairs from affected areas under a microscope.
If, after an initial clinical examination, the doctor is not able to make a diagnosis, they can perform a skin biopsy. If they need to rule out other autoimmune diseases, they might perform a blood test.
As the symptoms of alopecia areata are so distinctive, making a diagnosis is usually quick and straightforward.
Treatments for alopecia areata
Unfortunately, there is currently no cure for alopecia areata, although there are some forms of treatment that can be suggested by doctors to help hair re-grow more quickly.
The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. These can be administered through local injections (most common), topical ointment application, or orally.
Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE, and DPCP. Although some of these may help with the re-growth of hair, they cannot prevent the formation of new bald patches. Some people turn to alternative treatment methods such as acupuncture and aromatherapy, although there is little, if any, evidence to support these treatments.
The use of photochemotherapy is supported by some studies and presents a potential alternative for patients unable or unwilling to use systemic or invasive therapies.
In addition to its aesthetic aspect, hair affords a degree of protection against the elements. People with alopecia areata who miss the protective qualities of hair may wish to:
- Wear sunscreen if exposed to the sun
- Wear wraparound glasses to protect the eyes from the sun and debris which the eyebrows and eyelashes would normally defend against
- Use headwear such as hats, wigs, and scarves to protect the head from the sun or keep it warm
- Use ointment inside the nose to keep membranes moist and to protect against organisms that are normally trapped by nostril hair
Alopecia areata does not directly make people sick, nor is it contagious. It can, however, be difficult to adapt to emotionally. For many people, alopecia areata is a traumatic disease that warrants treatment addressing the emotional aspect of hair loss, as well as the hair loss itself.
Support groups and counseling are available for people to share their thoughts and feelings, and to discuss common psychological reactions to the condition.
Alopecia areata has been compared by some to vitiligo, an autoimmune skin disease where the body attacks melanin-producing cells, leading to white patches. Research suggests that these two conditions may share a similar pathogenesis, with similar types of immune cells and cytokines driving the diseases and common genetic risk factors.
As such, any new developments in the treatment or prevention of either disease may have consequences for the other.
Preliminary research in animals has found that quercetin, a naturally occurring bioflavonoid found in fruits and vegetables, can protect against the development of alopecia areata and effectively treat existing hair loss.
Further research is needed, including human clinical trials, before quercetin can be considered a treatment for alopecia areata.