Alopecia areata is an autoimmune disease that causes the body's immune system to attack hair follicles. Most people with this condition lose hair in small, round patches about the size of a quarter, according to the National Institutes of Health (NIH).
Hair loss may be limited to just a few patches on the scalp, beard or anywhere hair grows. Sometimes, though, all the scalp hair is lost. This is called alopecia areata totalis, and it's uncommon. Alopecia areata universalis, or complete loss of all body hair, is also uncommon.
People with alopecia areata are generally healthy otherwise, although those who lose their eyelashes, eyebrows and nose hair are more vulnerable to dust and germs.
Who gets it?
Alopecia areata can affect men and women of any age or ethnic background.
The exact cause isn't known. But research suggests that some people may have genes that predispose them to the disease. In these people, some type of trigger—possibly a virus or something in the person's environment—causes the immune system to suppress the hair follicles.
The follicles remain alive, though, and can resume normal hair growth at any time.
What can be done?
For some people with alopecia areata, the hair regrows and the condition never returns, reports the American Academy of Dermatology (AAD). Hair may also fall out and grow back for many years.
There are no drugs approved specifically to treat alopecia areata, but some that are approved for other purposes are used for this condition. According to the AAD, the following medicines may also help hair grow back temporarily:
Corticosteroids. This medicine is injected directly into the hairless patches every four to eight weeks. Hair usually begins to grow about a month after treatment begins.
Topical minoxidil 5% solution. This solution is applied twice a day to the affected areas. New hair may appear in about four months. This treatment doesn't work for total scalp hair loss. Minoxidil is most often used along with another treatment.
Anthralin. This is a synthetic, tarlike substance that alters the immune function in the affected skin. It is applied daily and is often used in combination with other treatments. It may grow hair in about 8 to 12 weeks.
Topical immunotherapy. These medications are applied to the scalp to provoke an allergic reaction that causes itching, scaling and, eventually, hair regrowth. About 40% of patients regrow hair after about six months.
None of these treatments cures the underlying disease, and they don’t prevent new bare patches from appearing. They all must be continued regularly or hair loss will return.
For some people, a wig or hairpiece might be the best way to cope with alopecia. Scarves, bandannas or hats can also help, especially for children. And makeup can hide small bare patches.
People with extensive hair loss who don't wear a wig should wear a hat or sunscreen to protect their scalp. Glasses or sunglasses can protect the eyes from dust when eyebrows and lashes are missing.
What is the outlook?
Even after many years of hair loss from alopecia areata, hair may completely regrow. And researchers are looking at new treatments, including better ways to administer drugs and therapies that work for other autoimmune diseases.
For more information, support groups and message boards, contact the National Alopecia Areata Foundation at naaf.org.
Reviewed 9/15/2023