Alopecia areata

About alopecia areata

Alopecia areata affects your hair follicles, causing patches of baldness. It’s very likely that if you have only partial hair loss, your hair will grow back fully within one to two years. However, for some people it can take many months or years. The hair that grows back may be white, at least at first. The condition doesn't permanently damage your hair follicles, so even if you have hair loss in any one area for a long time, your hair may still grow back.

About one or two people in every 1,000 in the UK have alopecia areata. The condition can develop at any age, but it's most common in young people aged between 15 and 29 – six out of 10 people with alopecia areata develop it under the age of 20. It affects men and women equally.

In some people, alopecia areata can be a chronic condition. A chronic condition is one that lasts a long time, sometimes for the rest of your life. When describing an illness, the term ‘chronic’ refers to how long you have it, not to how serious it is. Alopecia areata may also be a relapsing condition – this means that the condition can come and go.

Alopecia areata doesn't harm your health in any other way.

Symptoms of alopecia areata

Some of the main symptoms of alopecia areata include the following.

  • You may have patchy hair loss that appears as small, round areas of baldness. These areas are most likely to be on your scalp, although they can occur on any part of your body where there is hair, including your eyebrows, beard and arms or legs.
  • Usually the exposed skin will look smooth and healthy, but rarely it can be red or scaly.
  • You may have short, broken hairs at the edges of the bald patches. These are called exclamation hairs and are thinner at the end nearest to your head.
  • Your nails may be affected, most commonly becoming pitted.
  • You may get a tingling or itching sensation on your scalp, but usually you won’t feel anything.

Alopecia areata

Complications of alopecia areata

If you have alopecia areata, you may be more likely to get other autoimmune conditions such as thyroid disease and vitiligo. Autoimmune conditions happen when your body’s immune system attacks your organs and tissues because it mistakenly identifies them as foreign.

Sometimes alopecia areata can progress to the loss of all the hair from your scalp (alopecia totalis). It's very rare that you will lose all your body hair, but this can happen (alopecia universalis). The younger you are when the condition begins, the more likely it is that the condition will become more extensive. The greater the extent of your hair loss, the lower your chance of the condition going away completely.

Causes of alopecia areata

It isn't fully known why some people develop alopecia areata. It’s an autoimmune disease, which means your body's immune system attacks your hair follicles. This reaction prevents new hair from forming and causes existing hair to fall out.

Up to 20 in 100 people with alopecia areata have a family member who also has the condition. This suggests that alopecia areata may be caused by genetic factors. Genes are found in every cell in your body and carry the codes that determine your characteristics, such as your hair and eye colour. You inherit your genes from your parents. It's possible that having a certain combination of genes makes you more likely to develop alopecia areata, although other factors probably also play a part.

If you or a close member of your family has another condition that involves the immune system, such as eczema or thyroid disease, or are prone to allergies, you may be more at risk of alopecia areata.

The condition is also more common in people who have Down’s syndrome. There is also some evidence that the condition can develop after a stressful event, such as bereavement.

Diagnosis of alopecia areata

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If there is a possibility that you have other autoimmune conditions, you may also have blood tests.

Your GP may refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions), if you have severe hair loss or if your GP isn’t sure about your diagnosis. Very rarely, your doctor may recommend that you have a biopsy of your scalp – this is a small sample of tissue, which will be sent to a laboratory for testing.

Treatment of alopecia areata

Often your hair will grow back within a year without any treatment, particularly if your hair loss is patchy and involves less than half of your hair.

There are a number of treatments that you may want to try, although their effectiveness varies for everyone. Some treatments for alopecia areata may encourage your hair to grow back, although none of them can completely cure the condition.

Self-help

If you have mild alopecia areata, you may decide not to have any treatment. Your GP may suggest that you wait for up to three months to see whether your hair grows back without treatment.

You can wear a hat or a bandana to cover up any patches of hair loss. Alternatively, you may wish to consider wearing a wig, which can be of human or synthetic hair. You can sometimes get a prescription from your GP for a wig – ask him or her for more advice about wigs.

Your hair usually provides some protection from the sun to the skin on your head. If you have alopecia areata, it’s important to take care to apply sunscreen to the areas of hair loss if you’re outside in sunny weather. Make sure you use a broad spectrum sunscreen – this means it protects your skin against both ultraviolet A (UVA) and UVB rays. It should have a sun protection factor (SPF) of at least 15. It's also a good idea to wear a hat when you’re outdoors.

Medicines

There are many different medicines that you may wish to try depending on the severity of your hair loss. However, these aren’t usually recommended unless your condition is very severe.

Topical
The most common treatment for alopecia areata is with steroid creams, ointments or lotions. You apply a thin layer directly onto your patches of baldness. Although you're unlikely to have any side-effects because you will probably only use these for a short period, the effectiveness is unpredictable. Topical tacrolimus is also sometimes used because it suppresses your immune response.

Corticosteroid injections
Rarely, your doctor may offer you corticosteroid injections into your patches of baldness. These are usually only used for small, visible, isolated patches of hair loss – large areas can’t be treated. These injections may need to be repeated after six to 12 weeks and you will probably need to go into hospital for them. Your hair will usually start growing back within four to six weeks of starting the treatment and may keep growing for six to nine months after an injection. Side-effects of this treatment can include pain during the injection. Also, especially with repeated injections, you may notice a dent on the surface of your skin caused by loss of fat and thinning of the middle layer of your skin – this is usually temporary. It's important that you’re aware that even if treatment is successful, alopecia areata may still come back.

Oral corticosteroids
You may be prescribed corticosteroid tablets – however, these are rarely offered even if your hair loss is very severe. This is because their effectiveness is unreliable and any regrowth is often lost once you stop taking the tablets. It’s not advisable to take oral corticosteroids long-term as they can have many serious side-effects, including raised blood pressure and stomach ulcers. Other types of medicines that reduce the action of your immune system have been tried, but are seldom recommended for alopecia areata.

Contact sensitisation
Alopecia areata is thought to be caused by a problem with your immune response. It's sometimes possible to trick your immune system into changing the things it reacts to. This is done by applying a chemical to your skin that causes an allergic reaction in that area. If applied to areas of hair loss, it may cause your hair to start growing again. This treatment is called contact sensitisation or contact immunotherapy.

Contact sensitisation isn’t widely available in the UK. The treatment involves several months of hospital visits, and you need to cover the skin that has been treated for about two days because sunlight will damage the chemicals used. It may also lead to loss of the colour of your skin in the treated areas. The success of the treatment depends on a number of things, including how extensive your alopecia areata is and how long you have had the condition.

Minoxidil solution or lotion
Minoxidil solution (Regaine) may help your hair to grow more, but its effectiveness varies. It takes about 12 weeks to work, but you will need to keep using it to maintain hair growth. This treatment may be helpful in thickening up hair around your bald patch, which may help to hide it. Side-effects can include red and itchy skin. You can buy minoxidil from a pharmacy.

Hospital treatment

You may be offered treatment with ultraviolet (UV) light. This uses a medicine called psoralen plus UVA light and is called PUVA.

You will have psoralen applied to your skin or take it by mouth. Your skin is then exposed to UVA light, which activates the psoralen. You will usually need to have this done twice a week for several months. If you’re given the tablet version, you will need to stay out of the sun and wear photoprotective glasses all day when you have this treatment. PUVA can make you feel sick and cause changes to your skin colour. It also increases your risk of skin cancer.

Talking therapies

It can be upsetting having alopecia areata, especially for children or young people. If you’re having trouble dealing with your hair loss, talk to your GP. He or she may suggest counselling to help you cope. You may want to join a support group, as it can be helpful to talk to other people with the same condition.

Are there any conditions that can be confused with alopecia areata?

Answer

Yes, there are a number of other conditions that have similar symptoms to alopecia areata. Not all hair loss is a result of alopecia areata.

Explanation

Your GP will consider a number of other conditions as well as alopecia areata when hearing about your symptoms and examining you – some of these are described here.

There is a condition called scalp ringworm (tinea capitis) that has some of the same symptoms as alopecia areata. It's a fungal infection that can cause patchy hair loss, mainly in children. However, it's different from alopecia areata in that the areas of baldness are likely to be red, scaly and itchy. You may have nodules in these patches, which can be painful. You will probably have broken hairs within the bald areas, but these aren’t the same as the exclamation hairs found in alopecia areata.

If you notice that your hair appears to be falling out at an increased rate, you may have another type of hair loss called telogen effluvium. This tends to cause generalised hair thinning rather than patches of total baldness like alopecia areata. With this type of hair loss your hair will usually grow back after three to six months. Telogen effluvium can sometimes happen after:

  • having a baby
  • long-term illness
  • severe illness where you had a high temperature
  • major surgery
  • crash-dieting, anorexia or other big changes in your diet

I've heard it's possible for women to get male pattern baldness - is this true?

Answer

Yes, there is a condition called androgenetic alopecia, which affects both men and women. It’s sometimes called androgenic alopecia or male pattern baldness.

Explanation

Many people lose hair as they get older, usually because of a condition called androgenetic alopecia. This has a number of causes including your genes, age and hormones. It’s a common condition that affects up to half of all men by the age of 50. In women, the condition is much less common and usually begins after the age of 40, but it’s much more likely to develop after the menopause.

Androgenetic alopecia affects everyone differently, but doesn’t affect the hair at the sides or back of your scalp as much as that at the top or front. In men, the hair can be lost from the front and over the top of the head eventually leaving a curve of hair around the sides and back. In women, the pattern can be the same, but often there is no hair loss at the front of the scalp and the extent of hair loss is generally much less obvious.

Androgenetic alopecia happens when the hair follicles in your scalp gradually get smaller. This means that the hairs stop growing earlier in their growth cycle and fewer new hairs are produced. The hairs will also be thinner because they don't have as long to thicken before they stop growing.

Androgenetic alopecia can be treated, but success rates vary. Ask your GP or pharmacist for information about the options available to you.

Is it possible to have a hair transplant to treat alopecia areata?

Answer

Hair transplants move hair follicles from one part of the scalp to another. Alopecia areata can affect any part of your body that has hair so the transplanted hair would not necessarily be 'protected' from alopecia areata. Therefore, this treatment isn't generally recommended for alopecia areata.

Explanation

There are many clinics that offer hair transplant surgery. This type of treatment is still quite new, so it's important to find out as much as possible about the risks and benefits of the procedure before you decide to have it.

Hair transplant surgery involves removing a strip of healthy, growing hair from one part of your scalp. This is then divided into much smaller pieces, sometimes individual hair follicles, and these are inserted into areas where your hair is thinner. You may need to have more than one operation depending on how much hair loss you have and how much hair you wish to gain. The transplanted hairs should start to grow within three to four months. The success of this operation depends on how much healthy hair you have available to transplant. This procedure isn’t usually recommended for alopecia areata.