1. What is Alopecia Areata?
  2. What medical treatments are available?
  3. Are there natural treatments for Alopecia Areata?
  4. What causes Alopecia Areata?
  5. About the symptoms
  6. What types are there?
  7. How to cope with Alopecia?
  8. How is it diagnosed?
  9. Diet and Alopecia Areata
  10. How to prevent it?

Alopecia areata affects an estimated 15 in 10,000 people in the UK, according to the National Institute for Health and Care Excellence (NICE). As this condition causes hair loss on the scalp and other areas of the body, it can be incredibly difficult to live with — but treatments are available.

How do you know if you have alopecia areata, and what can you do to change it? We’ll answer these and other essential questions about the condition in this complete guide, covering symptoms, causes, treatments, and more.

What is Alopecia Areata?

Alopecia areata occurs when the immune system mistakenly identifies the hair follicles as a threat and attacks them. This causes patchy hair loss that may be unnoticeable to everyone but the person affected. However, these isolated patches can join together over time and make the hair loss more visible.

Hair loss usually starts on the scalp, and can be sudden. But in some cases, alopecia areata may affect hair elsewhere on the body (such as the eyelashes and eyebrows). It may appear to stop, but can return after a number of years.

Alopecia areata may develop into alopecia universalis: complete hair loss across the body. This condition can stop hair from growing back, and if it does, new hairs may fall out. The severity of hair loss and potential regrowth differs from one person to another.

At present, no cure for alopecia areata exists, but a number of treatments can encourage affected hair to grow back and prevent recurrent loss in the future. Other solutions enable you to simply cover your hair loss instead of stopping it.

alopecia areata

What Medical Treatments are Available for Alopecia Areata?

Various treatments can help you slow your hair loss or stimulate regrowth. It can be hard to predict how alopecia areata will progress or respond to treatment, though, so you may need to experiment before you find a solution that helps you. Hair loss can become more severe for some people, even while undergoing treatment.

Three types of medical treatments are available:

Topical

Topical agents applied directly to the scalp can stimulate hair growth. You may buy topical treatments over the counter or with a prescription from your doctor.

  • Minoxidil: Minoxidil (available as Rogaine) is an over-the-counter treatment applied to the scalp, beard, and eyebrows (if necessary). This is usually used twice per day, though you could wait years for results to develop. Minoxidil is generally considered safe, though you should consult your doctor before you try it. However, the results of one study suggested that minoxidil is less effective for people with extensive hair loss caused by alopecia areata.
  • Corticosteroids: Creams, lotions, and other types of corticosteroid products can combat hair loss by reducing follicular inflammation.
  • Topical immunotherapy: This approach involves applying diphencyprone or other chemicals to the skin to trigger an allergic reaction. The resulting rash can trigger new growth, but results will take up to six months to appear.
  • Anthralin: Available as Dritho-Scalp, this drug causes skin irritation that promotes regrowth.

Oral

cortisone tablets may be prescribed to treat alopecia areata

One type of oral treatment for alopecia areata is cortisone tablets. These are sometimes used to treat advanced alopecia, though it can lead to side effects. It’s best to speak to your doctor before you try this option.

Alternatively, you could talk to your doctor about an oral immunosuppressant (e.g. cyclosporine or methotrexate). These block immune system responses but are unsuitable for long-term use, as they can lead to side effects such as kidney damage and high blood pressure.

Light Therapy

Light therapy (also known as phototherapy or photochemotherapy) is a form of radiation treatment. This is performed with ultraviolet (UV) light alongside psoralens, an oral medication.

Injections

Injecting steroids into areas affected by mild alopecia areata can encourage hair to grow back. This must be performed once per month or every 2 months to cultivate results. However, steroid injections won’t prevent further hair loss.

What Natural and Alternative Treatments are Available?

If you’d prefer to avoid medical treatments, or they haven’t worked for you, you may want to try a natural or alternative option instead. These include:

  • Acupuncture
  • Microneedling
  • Aromatherapy
  • Hair growth oils (e.g. peppermint, lavender)
  • Coconut oil, olive oil, and other oils
  • Low-level laser therapy (LLLT)
  • Probiotics
  • A restrictive diet referred to as the “autoimmune protocol”, including lots of vegetables and meats
  • Scalp massage for hair growth
  • Applying onion juice to the scalp (one study found this can be effective)
  • Hair growth vitamins and minerals (including zinc)
  • Herbal supplements (such as ginseng and saw palmetto)
  • Drinks and topical agents containing aloe vera

The majority of alternative therapies have yet to undergo testing in clinical trials. As a result, it’s unknown how effective they can be in treating hair loss. Be careful when purchasing products from the U.S., as the Food and Drug Administration (FDA) doesn’t require companies to prove that their supplements are safe. Information on packaging may be misleading.

Similarly, food supplements don’t need to be registered with the government or licensed in the UK, though they’re regulated under the Food Safety Act (according to the Health and Food Supplements Information Service). Check with your doctor before you try a supplement of any kind, just in case.

Treatments affect people in different ways: some won’t see any results while others find their hair grows back naturally. Any regrowth that occurs may be temporary only.

What Causes Alopecia Areata?

As an autoimmune condition, alopecia areata causes the immune system to fight the hair follicles because it misidentifies them as foreign substances (such as bacteria or a virus). Follicles on the scalp grow in a four-stage cycle, but they will shrink until they stop creating hair altogether. This leads to patchy hair loss.

Researchers don’t understand the exact cause of alopecia areata, though it tends to affect people with a family history of this or other autoimmune conditions (like rheumatoid arthritis).

Scientists believe that a person’s genetics means they’re more likely to have alopecia areata, though environmental factors may encourage the condition to take effect.

What are the Symptoms of Alopecia Areata?

patchy hair loss is a common symptom of alopecia areata

Hair loss is the primary symptom of this condition. It typically occurs in patches across the scalp, often no bigger than a few centimetres. However, hair loss may affect the beard, eyelashes, eyebrows, and other areas too.

You may start to find more hair on your pillow in the morning or in the shower drain before you spot thinning patches on your scalp. Someone else might notice them first if they’re on the back of your head. But alopecia areata isn’t diagnosed on hair loss only, as various other conditions can trigger it too.

Other types of alopecia can lead to more advanced hair loss, including alopecia totalis (affecting the entire scalp) and alopecia universalis (affecting the whole body). You may lose all the hair in one or two areas, such as the leg or scalp, but not everywhere.

Researchers and doctors believe that alopecia areata’s hair loss can be spontaneous, and it’s impossible to predict: hair can grow back but fall out once more without warning.

How Does Alopecia Areata Affect Men?

When men develop alopecia areata, it’s likely that other members of their family have previously been affected by the condition too. Alopecia areata is also likely to cause more extreme hair loss in men than women: men may lose hair from their face, scalp, back, and chest. It’s different to male pattern baldness, though, as alopecia areata occurs in patches.

How Does Alopecia Areata Affect Women?

Women are more likely to experience alopecia areata than men, though scientists have no idea why yet. It can affect their scalp, eyelashes, and eyebrows.

Alopecia areata is restricted to small areas of the scalp, unlike female pattern hair loss, and could occur all at the same time. Thinning or bald patches may grow and connect to create more severe hair loss.

How Does Alopecia Areata Affect Children?

Alopecia areata can affect children as well as adults. People usually start to develop the condition before they turn 30. However, while alopecia areata is inherited from relatives in some way, a parent won’t always pass it on to their child. Kids may develop the condition even if their parents never have.

On top of hair loss, though, alopecia areata can also trigger nail defects in children (such as lesions and pitting). This can also affect adults with the condition, though it’s more common in children.

For children younger than 5 years old, alopecia areata usually causes little to no emotional issues (according to the National Alopecia Areata Foundation). But older children may find their hair loss harder to accept, as they’re more aware of looking different to other people their age. It may be best to visit a paediatrician if you believe your child is experiencing emotional difficulties because of the condition.

What Types of Alopecia Areata are There?

There are multiple forms of this condition. Each is identified by the severity of hair loss and additional symptoms. Treatment and prognosis for each type of alopecia areata may differ. 

Alopecia Areata

The key characteristic of this condition is the development of at least one patch of hair loss, usually no bigger than a coin, on the scalp or other parts of the body. These may expand and become another type of alopecia: totalis or universalis.

Alopecia Totalis

This condition causes full hair loss on the whole scalp.

Alopecia Universalis

Alopecia universalis triggers hair loss on the scalp and other areas of the body, possibly all of it (including pubic hair).

Diffuse Alopecia Areata

This type of alopecia resembles male or female pattern baldness. It leads to sudden hair loss on the entire scalp, rather than a single patch.

Ophiasis Alopecia

People affected by ophiasis alopecia experience hair loss on the lower back and sides of the head.

What is the Prognosis?

Alopecia areata is unpredictable, so the prognosis varies from person to person. You may lose hair and experience other symptoms intermittently for the rest of your life after you develop alopecia areata for the first time. But someone else might lose some of their hair once and never develop symptoms again.

Recovery can also be different: one person might regrow all their hair, but another may not. The following factors usually suggest that a person is likely to experience further problems with this condition:

  • Developing alopecia areata at a young age
  • A family history of the condition
  • Losing significant amounts of hair
  • Being affected by other autoimmune conditions
  • Experiencing changes in appearance of the nails

How Do People Live with Alopecia Areata?

Alopecia areata can be difficult to live with, particularly in its more extreme forms. People who lose hair on their entire scalp and other parts of their body may become frustrated and lose confidence in their appearance. But it’s vital to remember that you’re not the only person affected, and that there are ways to cope with the condition.

For example, wearing a wig can be a simple but effective option for keeping your hair loss discreet. You can also experiment with eyebrow stencils and eyelash extensions if you have lost hair all over your head. You’ll find many videos covering wigs and makeup on YouTube.

If you’re active, whether playing sports or performing heavy lifting at work, you can stick a wig to your scalp with a suction cup or glue. Innovative options (such as the vacuum wig) are designed for people who want to swim without losing their hair in the water. These can be costly, though, so won’t be suitable for everyone.

One option for dealing with thinning eyebrows is a hair tattoo. With this method, the eyebrows are tattooed to resemble natural hair with careful strokes. The results can last up to 3 years. Eyelash extensions typically require lashes to attach to, though it’s possible to use them even if you have lost your eyelashes.

How Do Doctors Diagnose Alopecia Areata?

hair and scalp examination is needed to diagnose alopecia areata

A doctor should be able to diagnose alopecia areata after examining your scalp, your hair loss, and several hair samples. They may also take a skin sample from your scalp to eliminate other potential conditions, such as a fungal infection. Analysing this sample will help them determine the cause of your hair loss.

However, you may also need a blood test if your doctor believes you have an autoimmune condition. The type of blood test they’ll use will depend on the suspected condition, but they’ll also check for signs of other unusual antibodies. When these are present in a blood sample, it typically indicates an autoimmune disorder. Various blood tests can help identify other potential conditions causing hair loss, such as:

  • Antinuclear antibody test
  • Iron levels
  • Thyroid hormones
  • Follicle stimulating and luteinizing hormone
  • Free and total testosterone
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)

Your doctor should explain why they’re performing these tests and what they’re looking for.

How Does Your Diet Affect Alopecia Areata?

Certain foods and drinks can exacerbate irritation and inflammation inside your body, such as sugary foods, processed snacks, and alcoholic drinks. An anti-inflammatory diet can help people with an autoimmune disorder by reducing the body’s autoimmune response. As a result, you can decrease your likelihood of further hair loss.

You’ll need to eat foods known to help reduce inflammation. In a diet like this, vegetables and fruits serve as the foundation. Common core elements include broccoli, lean meats, nuts, blueberries, and seeds. Switching from your usual eating routine to an autoimmune diet can take some time, and you may find it challenging. But it can be worthwhile if you want to help ease your current hair loss or prevent it from coming back.

Adopting a more balanced diet containing vegetables, whole grains, and fruits can benefit your health in other ways too. For example, you’ll get more of the vitamins, minerals, and other nutrients your body needs to function at its best.

What Can You Do To Prevent Alopecia Areata?

As the exact cause of alopecia areata is still unknown, preventing this condition can be difficult — if not impossible. Several factors may lead to alopecia areata, including autoimmune disorders, skin problems, and a family history of the condition. However, if you have any of these factors, you’re still not guaranteed to develop alopecia areata. This unpredictability makes the condition hard to understand and prevent.

A consultation with a hair loss specialist is crucial to determine the right treatment and to discuss the results you can expect to achieve.

FAQ

What should be avoided in alopecia areata?

People affected by the inflammatory disorder alopecia areata may try the Autoimmune Protocol (AIP) elimination diet. This involves avoiding dairy, coffee, alcohol, oil, sugar, food additives, eggs, legumes, grains, peppers, potatoes, and other nightshades. You will gradually incorporate these eliminated foods back into your diet one by one to determine which causes the reaction. 

What triggers alopecia areata?

As an autoimmune disease, alopecia areata occurs when the immune system attacks the hair follicles after wrongly identifying them as invaders. Cells in the immune system surround the follicles and attack them, triggering hair loss.

How fast does alopecia areata spread?

Those affected by alopecia areata usually develop circular patches of full hair loss on the scalp. This process takes a few weeks, though regrowth should occur within several months. 

Who is most affected by alopecia areata?

Alopecia areata causes hair loss in men and women equally. This disease can affect people of all ages, though it usually starts to manifest in childhood. According to the National Institute for Health and Care Excellence (NICE), around 15 in 10,000 people have alopecia areata in the UK.